Dermatologists see many patients interested in improving their physical appearance through cosmetic procedures or medical means. Dermatologists frequently counsel patients on sun protection as well, particularly those with a personal or family history of skin cancer, sun-sensitive dermatoses or those with obvious sun damage. Our objective in this study was to identify novel markers of skin cancer risk, which may aid dermatologists in targeting extra sun protection counseling for certain groups. A 16-question survey was distributed to subjects 19years of age and older in public areas of downtown Birmingham, Alabama in August and September of 2008. Overall, about 40% of both genders reported that they were highly concerned that current sun exposure could cause skin cancer. Participants interested in at least one appearance-related questionnaire item were significantly more likely than those not interested to rate tanned skin as highly important (31.6%vs. 17.5%, P<0.001), and to report regret for previous sun exposure (12.5%vs. 3.6%, P<0.001). Subjects who thought tanned skin was important were significantly more likely to report interest in improving their appearance through cosmetic procedures and medical means. We conclude that individuals with an interest in improving their physical appearance through cosmetic procedures or medical means may be especially in need of sun protection counseling. © 2011 Wiley Periodicals, Inc.