Derm Dx

An 88-year-old white man with a history of nonmelanoma skin cancer presented for a skin cancer surveillance visit with complaints of a 3-year history of a pruritic scalp. Triamcinolone cream had failed to resolve the problem.

An examination revealed a large, shiny, erythematous patch that was not indurated. There was no scale. Barely palpable papules were scattered throughout the lesion. What's your diagnosis?

Photos courtesy Dr. Jenny Murase