BACKGROUND:: Verrucous venous malformation (VVM) usually presents as verrucous hyperplasia of the epidermis and proliferation of vessels in the dermis and subcutaneous tissue. Atypical VVM without verrucous manifestation was recently reported. METHODS:: We retrospectively analyzed the clinical and histological features of VVM with minimal or no verrucous hyperplasia in 16 patients at a single dermatology department from 2002 to 2021. RESULTS:: All patients presented with palpable soft nodules or masses. Slightly red or light pink patches were present on the surface in 8 patients, while no obvious superficial abnormalities were present in 8 patients. In nine patients, the proliferated tissue was excised without the overlying epidermis, and in the other seven patients, the proliferated tissue with the intact epidermis was available for histological examination. All specimens showed proliferation of small to medium-sized vessels mainly in the subcutaneous tissue. Of the seven specimens with intact epidermis, five exhibited slight vascular endothelial hyperplasia in the papillary dermis and two showed no change in the papillary dermis. The endothelial cells were positive for CD31 (16/16) and focally positive for prox1 (8/16), D2-40 (14/16), Wilms tumor-1 (8/16), and Glut-1 (1/16). The pericytes around the endothelial cells were positive for smooth muscle actin (16/16). CONCLUSIONS:: VVM with minimal or no verrucous appearance is easily misdiagnosed. Clinicopathological correlation is very important for the correct diagnosis.