Multiple crusted lesions on the scalp

Case presentation

A 78-year-old man presents with multiple crusted irritable lesions on his scalp that he says have been slowly worsening over the past year (Figure). The lesions are irritable, causing him to pick and scratch. He has generalised sun damage and has had a history of actinic keratoses, basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).