I was sitting around one day watching too much Dexter, and I got to thinking of morbid stuff to paint. This was one of the ideas that came to mind. I originally wanted to do it as an acrylic painting and I still might, but at the time I felt like creating the image in Photoshop and trying to make the image look more like a painting (similar to concept art that I've seen other artists do).
Here is a sketch I came up with.
I went about this differently then I have with other drawings. Usually I out line drawings, then color and shade them then add texture if that is what I think will compliment the work. This one I wanted to look a little more painterly so I blocked out big groups of color and worked with very few layers. Final product below :