A verruciform xanthoma (VX) is an uncommon lesion confined mainly to the oral mucosa. The diagnosis is almost always made during a histologic examination. Histologically, it is characterized by papillomatosis, parakeratosis, and aggregates of foam cells in the connective tissue papillae. The histogenetic origin of the lipid-laden foam cells is controversial. Three cases of oral mucosal VX are reported, The immunohistochemical study showed that the foam cells were positive for CD68 and vimentin and negative for S-100. Based on our findings, we suggest that foam cells, as a histological hallmark of the lesion, are most likely derived from the monocyte-macrophage lineage. We failed to detect human papillomavirus in all 3 cases. Differentiating a verrucous carcinoma from VX is important, especially in small superficial lesions, which could lead to an inappropriate and excessive surgical intervention. Treatment of VX consists of a simple surgical excision and the prognosis is excellent.