INTRODUCTION
Skin self-examination (SSE) has been correlated with early detection of skin cancers; in one study over half of melanoma cases were self-recognized prior to diagnosis.1 Patients often reference photos from online resources to guide SSE prior to medical evaluation, which may improve the accuracy of self-detecting suspicious lesions.2 It is critical that the full spectrum of skin tones is represented when displaying online clinical images. The purpose of this study was to evaluate the inclusivity and representation of skin tones in photos of skin cancer on patient-facing websites.
MATERIALS AND METHODS
Six federally based and organization websites (.gov,.org) with information about skin cancer were selected, including CDC.gov, NIH.gov, skincancer.org, americancancerfund.org, mayoclinic.org, and cancer.org. All photos on skin cancer-related webpages were evaluated. Hyperlinks to outside websites were excluded. Within each photo, each person or skin was counted separately as a representation. Representations were counted every time they were displayed and categorized as per Figure 1. The published 5-tone Pantone swatch3 was used by three independent reviewers to categorize representations into "lighter- 
