Preventive Medicine 29, 349–354 (1999) Article ID pmed.1999.0555, available online at http://www.idealibrary.com on Do All Fair-Skinned Caucasians Consider Themselves Fair? 1 Simone L. Harrison, M.P.H., 2 and Petra G. Bu ¨ ttner, Ph.D. Skin Cancer Research Group, School of Public Health and Tropical Medicine, James Cook University, Townsville, Queensland 4811, Australia. INTRODUCTION Background. Fair skin color is a risk factor for skin cancer. We aimed to determine whether Caucasians The incidence of skin cancer is increasing in predomi- have an accurate perception of their skin color. nantly Caucasian populations, particularly those in- Methods. A convenience sample of 341 Caucasian habiting regions with abundant sunshine [1]. It has adults in Townsville, Queensland, Australia was asked long been established that fair skin color is an im- to categorize the color of their unexposed skin as fair, portant risk factor for both melanoma and non-mela- medium, or olive. Reflectance was measured on the noma skin cancer [2–4], as well as being strongly associ- inner upper arm (400–700 nm) for each subject to pro- vide an objective measure of inherent skin pigmenta- ated with the most important risk factor for melanoma, tion. numerous melanocytic nevi (moles) [5–10]. Results. The median skin reflectances at 685 nm for Prevention programs, prevention campaigns, and cli- the olive (68.7%), medium (68.9%), and fair (71.9%) nicians with an interest in preventive medicine often perception groups were very similar and were within target health messages at groups with specific risk fac- the reflectance range generally associated with a fair/ tors. For skin cancer, fair/light skin color is one such risk light complexion (67%). Of those with a skin re- factor that is favored because it is visually discernible. flectance 67%, 46.6% considered their skin medium However, in order to reach this target group, fair/light- or olive. Agreement between perceived and measured skinned people have to correctly identify themselves skin color was poor (  0.113), with 36.4% over-estimat- as such. Koh and co-workers [11] encourage experts ing and 16.4% under-estimating their skin’s natural pig- mentation. interested in improving the sun-protective behavior of Conclusions. Some Caucasians over-estimate their high-risk individuals to identify barriers to the adoption skin pigmentation and possibly the level of protection of preventive behaviors and reasons for perceptions of from sunlight this affords them. Skin cancer preven- low personal susceptibility. The results presented here tion campaigns that attempt to target those at greater provide a possible explanation for the perception of low risk of skin cancer, on the basis of fair/light skin color, personal susceptibility among some Caucasians. are likely to fail, as many of these individuals don’t In study situations, the difficulties usually experi- consider themselves fair.  1999 American Health Foundation and enced in obtaining reliable subjective estimates of skin Academic Press color have been largely over come by measuring the Key Words: skin reflectance; complexion; skin color; skin cancer prevention; agreement. reflectance of sun-protected skin at wavelengths be- tween 650 and 700 nm using a reflectance spectropho- tometer or a spectrocolorimeter developed in accor- dance with the recommendations of the Commission International de l’Eclairage [4,6–10]. These instru- ments provide objective and reproducible measure- 1 Queensland Health supported the analysis and writing phases ments of melanin density on a continuous scale [12–14]. of this project. The project was initiated and analyzed by the investi- gators. However, despite the availability of this technology, 2 To whom correspondence and reprint requests should be ad- some investigators continue to use subjective estimates dressed at the Skin Cancer Research Group, School of Public Health of skin color. This article presents data that should and Tropical Medicine, James Cook University, Townsville, Queens- land 4811, Australia. Fax: +61 7 47225788. E-mail: Simone. discourage the subjective assessment of skin color in Harrison@jcu.edu.au or Petra.Buttner@jcu.edu.au. research. 349 0091-7435/99 $30.00 Copyright  1999 by American Health Foundation and Academic Press All rights of reproduction in any form reserved.