Do All Fair-skinned Caucasians Consider Themselves Fair?

Background: Fair skin color is a risk factor for skin cancer. We aimed to determine whether Caucasians have an accurate perception of their skin color.

Methods: A convenience sample of 341 Caucasian adults in Townsville, Queensland, Australia was asked to categorize the color of their unexposed skin as fair, medium, or olive. Reflectance was measured on the inner upper arm (400-700 nm) for each subject to provide an objective measure of inherent skin pigmentation.

Results: The median skin reflectances at 685 nm for the olive (68.7%), medium (68.9%), and fair (71.9%) perception groups were very similar and were within the reflectance range generally associated with a fair/light complexion (>/=67%). Of those with a skin reflectance >/=67%, 46.6% considered their skin medium or olive. Agreement between perceived and measured skin color was poor (kappa = 0.113), with 36.4% over-estimating and 16.4% under-estimating their skin's natural pigmentation.

Conclusions: Some Caucasians over-estimate their skin pigmentation and possibly the level of protection from sunlight this affords them. Skin cancer prevention campaigns that attempt to target those at greater risk of skin cancer, on the basis of fair/light skin color, are likely to fail, as many of these individuals don't consider themselves fair.