The article presents a case study of an 80-year-old woman, who was diagnosed with verruciform xanthoma on the thumb. The patient had no history of trauma or infection of the thumb. The patient had a hard verrucous lesion with epidermal hyperkeratosis and parakeratosis. The patient was treated with imiquimod and surgical excision for verruciform xanthoma. It examines the efficacy and safety of the treatment.