An older white person maybe a common presentation in the West? Our books say that it is rare. This is not a common presentation in our area.
In Southern Africa it is extremely common in younger patients who have HIV and lower CD4 counts. Eg when I was in Swaziland I was asked to do more than 20 SCC operations before I started on cataract surgery. We use a ‘no touch’ technique for excision with adjuvant therapy.