Your pathology report for xanthelasma

by Robyn Ndikumana MD FRCPC
September 12, 2025

Xanthelasma (pronounced zan-the-las-ma) is a non-cancerous growth that appears as a soft, yellowish patch on the skin around the eyes, most often on the eyelids. These growths are composed of special immune cells called histiocytes that have become filled with fat (lipids).

Because xanthelasma is harmless, it does not spread or turn into cancer. However, its presence can sometimes signal an underlying health issue that needs attention.

What causes xanthelasma?

Xanthelasma develops when fat builds up inside histiocytes. This typically occurs in individuals with high cholesterol or other abnormal blood lipid levels.

You may be more likely to develop xanthelasma if you have:

• High blood cholesterol or triglycerides.

• Diabetes.

• A genetic condition such as familial hypercholesterolemia, which causes very high cholesterol levels at a young age.

Even though xanthelasma itself is not dangerous, it can be a visible sign that your cholesterol is too high, which increases your risk for heart disease or stroke.

Why is the diagnosis of xanthelasma important?

The primary reason xanthelasma is essential is that it can serve as a warning sign. Many people first learn they have high cholesterol after they develop xanthelasma.

If you have been diagnosed with xanthelasma, your doctor may recommend:

• A blood test to check cholesterol and triglyceride levels.

• Lifestyle changes, such as adopting a healthier diet and exercising.

• Medication to help control cholesterol, if needed.

Who develops xanthelasma?

Xanthelasma is most common in middle-aged and older adults, especially women.

In younger people, xanthelasma is less common. When it does occur, it may indicate a genetic condition, such as familial hypercholesterolemia, which causes high cholesterol levels to develop in childhood or early adulthood.

How is the diagnosis made?

Often, doctors can recognize xanthelasma simply by looking at it due to its typical location and appearance.

Sometimes, to be certain, a doctor may remove a small sample of the growth in a procedure called a biopsy. The sample is sent to a pathologist, who examines it under the microscope to confirm the diagnosis.

What does xanthelasma look like under the microscope?

When examined under the microscope, xanthelasma is composed of large immune cells known as foamy histiocytes. These cells look swollen and pale inside because they are filled with tiny droplets of fat. Pathologists describe them as “foamy” because the fat makes the cells look bubbly, like they are full of clear foam.

These foamy histiocytes cluster together just beneath the surface of the skin, creating the soft yellowish patch that can be seen around the eyes.

Questions to ask your doctor

• Do I need a blood test to check for high cholesterol or triglycerides?

• Could my xanthelasma be linked to diabetes or another condition?

• What steps can I take to reduce my cholesterol levels?

• Are there treatments to remove the growth for cosmetic reasons if I want it gone?

• How often should I follow up with my doctor after this diagnosis?