The correct answer is E. Lesions are soft, velvety, yellowish in color (depending on skin tone), flat papules or plaques.

A xanthoma is a skin lesion caused by the accumulation of fat in macrophage immune cells in the skin and more rarely in the layer of fat under the skin.

Some types of xanthoma are indicative of lipid metabolism disorders (eg, hyperlipidemia or high blood fats), where they may be associated with increased risk of coronary artery heart disease and occasionally with pancreatitis.

Xanthomas are classified into the following types based on where they are found on the body and how they develop.

• Xanthelasmas are the most common type of xanthoma
• Lesions arise symmetrically on upper and lower eyelids
• Lesions are soft, velvety, yellowish in color (depending on skin tone), flat papules or plaques
• Lesions start off as a small bump and gradually grow larger over several months
• May or may not be associated with hypercholesterolemia or hypertriglyceridemia

These are the least common type of xanthoma: Xanthelasma is the most common type of xanthoma.

Associated with hyperglycemia: Lesions may or may not be associated with hyperlipidemia.

Lesions arise asymmetrically: Xanthelasma arises symmetrically on upper and lower eyelids.

Lesions start off as many bumps that grow rapidly: Lesions begin as a small bump and gradually grow larger over several months.

References: OMIM – Online Mendelian Inheritance in Man (search term Xanthomas) Book: Textbook of Dermatology. Ed Rook A, Wilkinson DS, Ebling FJB, Champion RH, Burton JL. Fourth edition. Blackwell Scientific Publications
Lin, X, Hu, H, Qian, Y, et al. Intralesional injection of bleomycin in the treatment of xanthelasma palpebrarum: A clinical study. J Cosmet Dermatol. 2020; 00: 1– 6. https://doi.org/10.1111/jocd.13258. Journal.