Two methods for the assessment of severity of actinic skin damage were evaluated in a population-based survey of 1216 subjects. After controlling for the effects of age, skin texture changes graded by cutaneous microtopography were found to be associated strongly with the presence of solar keratoses and a past history of non-melanotic skin cancer. Changes in skin condition graded by paraocular photography had a weaker relationship with the presence of keratoses and showed no association with non-melanotic skin cancer. These results, together with a higher level of agreement between observers in grading cutaneous microtopographs, support the use of cutaneous microtopography as an index of actinic skin damage in epidemiological research.