Snapshot A 67-year-old man with male-patterned baldness comes to the dermatologist. He realized recently that the skin on his scalp was not smooth. He describes it as feeling rough, like “sandpaper.” While he is now retired, he was a gardener and often spent hours under the sun. Introduction Keratotic, pre-malignant lesions May lead to squamous cell carcinoma Epidemiology Common in fair-skinned individuals Common in elderly patients Results from significant lifetime sun exposure login to view 1 more bullet Presentation Symptoms login to view 2 more bullets Physical exam login to view 8 more bullets STUDIES Skin biopsy login to view 3 more bullets Differential Squamous cell carcinoma Actinic cheilitis Lentigo maligna Treatment Prevention login to view 2 more bullets Annual follow-up for skin cancer monitoring Lifestyle modification login to view 2 more bullets Surgical login to view 2 more bullets Pharmacological login to view 2 more bullets Complications Risk of progression to squamous cell carcinoma Prognosis Typically slow-growing and persistent if untreated