This 58-year-old woman was unaware there was a problem with her neck skin until friends took a picture and showed it to her. She was surprised and distressed, thinking the changes were new and therefore representative of serious disease.
She denies having any associated symptoms but does admit to a great deal of sun exposure over the years. Her history is significant for a basal cell carcinoma, removed from her chest many years ago. She also has a history of smoking and early COPD.
A solid sheet of fine, blanchable telangiectasias spreads across the patient’s upper anterior neck, extending down onto her chest. It spares the skin directly under her chin, leaving an unaffected white oval area.
Elsewhere, the patient has a great deal of dermatoheliosis superimposed on her type II skin, including solar lentigines, weathering, and focal solar elastosis.
What is the diagnosis?