Introduction: Xanthogranuloma is a rare, non-Langerhans cell histiocytosis that most commonly presents in infancy or early childhood. It is rare in adults, and when present are usually solitary. We present an unusual case of adult xanthogranuloma with multiple lesions. Case summary Our patient is a 66 year-old lady with a 10-year history of persistent lesions over her eyelids and cheeks. Physical examination revealed confluent yellowish-red plaques and nodules over the periorbital regions as well as yellowish plaques over both sides of the neck. Histological analysis revealed a pattern of diffuse dermatitis in the dermis consisting of foamy histiocytes admixed with a few Touton-type giant cells. She had mild thrombocytopenia but a bone marrow trephine and flow cytometry investigations were normal. Due to the chronic and disfiguring nature of the lesions, intralesional triamcinolone was given with moderate efficacy. Conclusion: Differentiating between adult xanthogranuloma and other xanthomatous disorders has therapeutic implications and requires correlation with the epidemiological, clinical, biochemical and histopathological features. Adult xanthogranuloma

Granular cell tumours are uncommon benign lesions with a predilection for the head and neck region. We report 9 cases of this rare tumour seen at the National Skin Centre, Singapore, between 1996 and 2006. Five patients were female and four were male. Patient ages were between 15 to 66 years, with a mean of 37.1 years. All 9 patients presented with an asymptomatic painless mass varying from a 1 year to 10 years duration, with a mean duration of 4 years. 6 of the patients were Chinese, 2 were Indian and 1 was Sri Lankan. Five tumors were in the head and neck, three were in the groin or genital regions, and one was in the limb. The tumours ranged in size from 0.3 cm (in the scrotum) to 2.5 cm (in the neck). On examination, none of the lesions had any features of malignancy. The pre-operative diagnosis was dermatofibroma in 3 patients, epidermal cyst in 5 patients, and adnexal tumour in 1 case. For 1 of the patients, there were 2 synchronous tumours present in the scrotum. Excision biopsy was performed for all patients and histology confirmed the diagnosis.