Verruciform xanthoma (VX) of the penis is an uncommon, benign lesion that may clinically mimic genital warts or malignancy. Although VX most frequently arises within the oral cavity, only 42 cases involving the penile region have been documented in the literature since its initial description in 1981. The underlying pathogenesis remains poorly understood. The majority of cases may be managed conservatively with medical therapy or simple surgical excision, as penile VX typically presents as a solitary lesion confined to a limited area. Notably, two cases managed by partial penectomy have been reported, this is the first case to report glans resurfacing as an alternative for extensive penile VX. The glans resurfacing procedure involves removal of the superficial epithelial layers down to the corpus spongiosum, followed by the application of a split-thickness skin graft (STSG). This technique is most commonly employed in the management of low-risk penile carcinoma.

We report the case of a man in his fifties presenting with complex penile VX following failed medical treatment. The lesion was confined to the glans penis and corona, involving approximately 50% of the total surface area. A tourniquet was applied to minimise intraoperative bleeding. The epitelium and subepithelium was excised en-bloc along with the VX, down to the corpus spongiosum to exclude local invasion. A 10cm x 0.016in (0.41mm) x 7.6cm split-thickness skin graft was harvested from the patient’s right thigh. The excised glans epithelium was subsequently reconstructed with the harvested STSG, secured in place using quilting sutures. The patient was reviewed face-to-face at one week post-operatively, remotely monitored at one month, and assessed again in person at three months.

This represents the first documented case of penile VX treated with total glans resurfacing. The technique yielded significantly improved short-term cosmetic outcomes, and no complications were reported at the three-month follow-up.

Glans resurfacing appears to be a promising reconstructive technique for patients with extensive VX of the penis. It offers excellent short-term outcomes with favorable cosmetic and functional results.