INTRODUCTION
Skin self-examinations (SSE) are an integral part of skin cancer surveillance, with the potential to reduce mortality from melanoma by 63%.1 Many patients rely on information found online, e.g. Google, during SSE prior to seeking medical care.2 Previous studies searching Google Images for various dermatologic conditions found only 5.7% of total search results displaying darker skin tones.3 This study complements previous findings by doubling the images analyzed and focusing on skin cancers. Additionally, this study incorporated the 5-tone Pantone swatch4 instead of the Fitzpatrick scale, allowing for a more targeted categorization of darker skin tones rather than misuse of a grading system intended to measure skin response to UV light.
MATERIALS AND METHODS
A Google Image search was conducted by 3 independent reviewers on Incognito browsers to minimize personal algorithm bias. Each reviewer assessed the first 100 images for the following searches: "Skin Cancer" (SC), "Melanoma", "Squamous Cell Carcinoma" (SCC), and "Basal Cell Carcinoma" (BCC). Each image was designated as "Lighter Skin Tone", "Darker Skin Tone", "Light and Dark Skin Tone", or "Inconclusive/Other" based on the published 5-tone Pantone swatch.4 "Lighter Skin Tones" included Pantones A-B or lighter while "Darker Skin Tones" included Pantones C-E or darker. Images where skin tone could not be differentiated were deemed inconclusive. Pantone shade for each image of darker skin tone was documented, along with the image number in the search; final results were compiled and averaged.
RESULTS
Darker skin tones were infrequently encountered in the first 100 Google Image results for each search term. 1200 pictures were evaluated, of which 95% (n=1140) depicted only lighter skin tones, 1.25% (n=15) displayed only darker skin tones, and
