Derm Dx: Comedones on the cheeks

A 79-year-old man presents for treatment of a forehead cyst that has been excised surgically. An incidental finding on examination is multiple open comedones affecting both cheeks. The patient states that these have been present for a long time and he is not concerned about them. The patient's facial skin is sallow, thickened, and leathery. He worked outdoors for decades ...