An atypical presentation of a verruciform xanthoma is discussed. Usually the surface of the lesion is rougher and more warty, and the lesions generally are larger. The foregoing case, however, serves to illustrate that all lesions, regardless of how small or innocuous, should be examined microscopically to determine a diagnosis and to develop a proper treatment plan. Rarely can a definitive diagnosis be made entirely on the basis of the clinical characteristics of the lesion.