Accompanied by family, a 68-year-old man presents for evaluation of changes on the left side of his face. His relatives, who have not seen him in years, find the changes quite alarming; the patient, however, is quite sure he has “looked this way for a while.” In any case, he has no associated symptoms.
He does have numerous other health problems, including hypertension, heart disease, and a 50–pack-year history of smoking. He has spent a great deal of time in the sun over the years, particularly when he drove a dump truck for work.
EXAMINATION
The left side of the patient’s face is covered with open and closed comedones superimposed on thickened, yellowed skin. Poikilodermatous changes and multiple telangiectasias can also be seen. The right side of his face demonstrates minor skin changes relative to the left.
What is the diagnosis?