Verruciform Xanthoma of the Buccal Mucosa: A Case Report Highlighting a Rare Architectural Variant and Diagnostic Challenge.

Verruciform xanthoma (VX) is a relatively uncommon, benign, reactive lesion of the oral mucosa, representing only 0.025%-0.05% of all oral pathology cases. Clinically, it often presents as an asymptomatic, solitary, yellowish-white, or red growth with a corrugated or verrucous surface. Because it frequently mimics verruco-papillary lesions, clinical diagnosis is achieved in only approximately 2% of cases. Consequently, histopathological evaluation remains the "gold standard," characterized by the pathognomonic accumulation of lipid-laden foamy macrophages (xanthoma cells) within the connective tissue papillae. This report highlights a rare presentation of VX on the buccal mucosa, a site involved in only 8.5% of documented cases. Notable findings in this case included a 10-year habit history of areca nut consumption. Rather than acting as a definitive etiological trigger, this habit served as a significant diagnostic confounder, elevating clinical suspicion of a malignant process. Histopathology confirmed the "flat" architectural variant, which is characterized by endophytic proliferation. Given the excellent prognosis following conservative surgical excision, this case emphasizes the need to include VX in the differential diagnosis of verrucous lesions to avoid overtreatment. The patients remained disease-free, with no evidence of recurrence during follow-up.