Actinic keratosis

QUESTION 49

An 87-year-old woman presents to the dermatology clinic for a routine total body skin examination. She has a history of chronic sun exposure and spends much of her time gardening. She has noted development of crusty papules on her hands and arms. The papules have grown in size over the last 6 months and occasionally flake off and bleed. On examination, there are erythematous hyperkeratotic papules symmetrically distributed over the dorsal hands and forearms (49).