Mr A is an 80 year old man who presents with several warty skin lesions on his forearms for past 6 months. There was no complaint of pain or itch except occasional irritation when he accidentally rubbed against them. He noticed that these skin lesions had gradually increased in size and number. Physical examination reveals extensive solar damaged skin on sun exposed areas of both forearms. There are scattered areas of hyperpigmentation (solar lentigo), isolated patches of hypopigmentation (solar hypomelanosis), skin atrophy, presence of wrinkles, telangiectasia and superficial areas of ecchymosis. Several small irregular, crusty, warty type of lesions were seen in this background of solar damaged skin. Mr A was referred to a dermatologist who performed a skin biopsy. Results came back as positive for squamous cell carcinoma (SCC). He was referred to a radiotherapist and received a full course of 30 fractions of curative doses of radiation. His warty skin lesions completely subsided but 2 years later similar lesions cropped up again at different sites on the forearms.