This is a bowl of spaghetti swimming with smallish skull-shaped sausage chunks. It looks as good as it smells, and, inexplicably, looks as well as it smells, too.
Eating 5 bowls of Spaghetti with Skullheads will earn the Platinum Skull trophy.
Without Stomach of Steel or on days other than the Feast of Boris, you'll take 3 days to earn this trophy. With Stomach of Steel, 2 days. On the Feast of Boris and also a combination of the two, you will earn the trophy in 1 day.
References
The consumption text refers to Mr Skullhead's apparent love of paddling the ladies.