This patient has actinic keratosis (AK), which presents as scaly papules or plaques, most commonly in fair-skinned individuals. Chronic sun exposure is the major risk factor, and surrounding skin often displays features of solar damage (eg, telangiectasias, hyperpigmentation). AK is found predominantly on the scalp, face, lateral neck, and dorsal surface of the hands. Its clinical significance is due primarily to the potential progression to squamous cell carcinoma, although the likelihood of malignant progression of an individual lesion is low. AK is diagnosed based on appearance, but biopsy is indicated for lesions that are >1 cm in diameter, have an indurated appearance, exhibit ulceration, are rapidly growing, or fail appropriate treatment. Histopathology shows thickening of the epidermis (acanthosis), retention of nuclei in the stratum corneum (parakeratosis), nuclear atypia, and abnormal keratinization with thickening of the stratum corneum. Individual lesions can be treated with focal cryotherapy (eg, liquid nitrogen), but involvement of a large area may require field therapy (eg, fluorouracil). Actinic keratosis is characterized by scaly papules or plaques on the scalp, face, lateral neck, and dorsal surface of the hands. Chronic sun exposure is the major risk factor. Actinic keratosis can progress to squamous cell carcinoma, but the likelihood of malignant progression of an individual lesion is low.Clinical features UV, ionizing radiation Immunosuppression Chronic scars/wounds/bum injuries Scaly plaques/nodules +/- Hyperkeratosis or ulceration Neurologic signs with perineural invasion