A 70-year-old man is seen for “broken blood vessels” on his face. The lesions were recently noted by a relative who had not seen him in years.
The patient has a pronounced history of sun overexposure as a result of his job and his hobbies, which include fishing and hunting. As a younger man, he enjoyed waterskiing and going to the lake almost every weekend during the warmer months.
He is in decent health apart from the lesions and has no other skin complaints.
EXAMINATION
The sides of the patient’s face are covered with linear, red, dilated blood vessels running in jagged patterns. The lesions are asymptomatic and range from 0.5 to 1.0 mm in diameter; some are several centimeters long. They are readily blanchable with digital pressure, though none are palpable.
Far more blood vessels are seen on the patient’s left side than on his right. The underlying skin is quite fair and thin. In some locations (eg, the lateral forehead), there are patches of white skin free of surface adnexa (ie pores, skin lines, or hair follicles).
His dorsal arms are very rough, with hundreds of solar lentigines, while the skin on his volar arms is relatively unaffected.
What is the diagnosis?