Changes in Self-Perceptions of Photoaging Severity and Skin Cancer Risk After Objective Facial Skin Quality Analysis

May 2017 | Volume 16 | Issue 5 | Original Article | 453 | Copyright © May 2017

Yoon-Soo Cindy Bae MD,a,b Edward Jong Bae BA,b Joyce H. Wang MD,b and Barbara A. Gilchrest MDb

aLaser & Skin Surgery Center New York, New York, NY; New York University, Department of Dermatology, New York, NY bBoston University School of Medicine, Boston, MA


Background: Despite public education efforts, many people at risk for skin cancer do not practice safe sun behaviors.

Objective: To determine whether machine-based evaluation of UV-induced alterations (VISIA scan) changes self-assessment of facial photoaging, skin cancer risk, and willingness to improve sun protective habits. In addition, to determine whether VISIA scan analysis reveals differences between those with versus without a history of skin cancer, men versus women, those older than 50 versus less than 50 years of age, and Fitzpatrick skin types I-III versus IV-VI.

Methods: Volunteers attending a health expo were recruited and queried about their perceived risk of skin cancer and degree of skin photoaging. All participants underwent facial skin quality analysis of both sides of the face, and then completed a follow-up survey.

Results: Participants’ scored self-perceptions of overall skin aging were all statistically significantly worse after VISIA scan analysis. There was no change in perceived skin cancer risk, but most participants expressed intent to improve their sun protection habits.

Limitations: Limitations to this study include selection bias, recall-misclassification bias, and social desirability bias.

Conclusion: Intervention with facial skin analysis can positively affect subjects’ stated intent to use sun protection, indicating the importance of appearance in these health decisions.

J Drugs Dermatol. 2017;16(5):453-459.


There are an estimated 3.5 million cases of non-melanoma skin cancer (NMSC), and over 100,000 new cases of malignant melanoma (MM) in the United States each year.1-6 The incidence of skin cancer is still on the rise and the great majority of these cases are potentially preventable by reducing ultraviolet (UV) exposure in at risk populations. However, despite extensive public health campaigns and recent advances in legislation regulating indoor tanning for minors, it remains difficult to influence the attitudes and behaviors of individuals toward sun protective behaviors. At present, most safe sun educational campaigns focus on skin cancer avoidance rather than the photoaging effects of chronic UV exposure.7 But for younger people who are less likely to feel the immediate threat of skin cancer, this approach is less than optimal. A more effective approach for influencing a broader population in the primary prevention of skin cancer may require incorporating an appearance-based tactic. Photoaging, in addition to being a cosmetic problem with psychosocial consequences, correlates with the development of skin cancer,8 and by definition is present only in chronically sun-exposed areas. While clinical examination of chronologically aged skin reveals mild dryness, laxity, fine wrinkles, and atrophy, photoaged skin is characterized by more prominent and coarser wrinkling and laxity, a dry and rough texture, and uneven pigmentation.9Americans of all ages are generally sensitive and responsive to improving their appearance. The American Society for Dermatologic Surgeons (ASDS) surveyed 6350 patients and reported that second only to excess weight, consumers were “most bothered” by lines and wrinkles around the eyes (63%), skin texture and/or discoloration (62%), sagging facial skin (61%), and lines, wrinkles, and/or folds in the mid-face around the cheeks and mouth (60%).10 The American Society for Aesthetic Plastic Surgery (ASAPS) reported that in 2012 over 10 million cosmetic surgical and nonsurgical procedures were performed, totaling almost $11 billion dollars.11 Taking into consideration the money spent by Americans on cosmetic procedures, it can be deduced that many people are highly interested in their appearance and are motivated to adopt habits that positively impact their overall attractiveness. A VISIA scan (Canfield Scientific, Fairfield, NJ) may be used to assess the various parameters of skin quality and photoaging. We hypothesized that by sharing the objective results of the scan with study subjects, we could motivate them to improve their intended sun protection practices and potentially alter their risk for skin cancer. We further hypothesized that subjects’