How would you manage this lesion on the elbow?

In this week's case discussion, submitted by Dr John O'Bryen, we look at a 69-year-old man with a history of actinic keratoses who presents with a rapidly growing, tender, scaly lesion on his right elbow.

What is your diagnosis, and what would you do next?

Update

An elliptical excision reports well differentiated squamous cell carcinoma with clear margins.

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