How would you manage this bleeding lesion?

This week's case discussion, submitted by Dr Mostafa Khalafalla, features a 55-year-old male patient with no previous personal or family history of skin cancer who attends for a skin check after his usual GP expresses concern about the actinic burden to his scalp as a risk factor for cutaneous malignancy.

No specific lesion is raised by the patient during the consultation, however an obvious bleeding ulcerated lesion is seen upon examination. The patient reports the lesion has been present for around 6 months and has been intermittently bleeding over the last 2 months. Also note several other keratonitic lesions adjacent.

Please see clinical and dermoscopic images. What do you think of this lesion?

Also see below dermoscopy of two other adjacent lesions, for context.

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