As the weather turns warmer and we in the healthcare community encourage Rhode Islanders to get active and spend more time outdoors, we are faced with an alarming truth: Rhode Island outpaces the national average when it comes to rates of diagnosed skin cancer. A recent Health of America report from the Blue Cross Blue Shield Association looked at prevalence rates for all types of skin cancers among commercially insured Americans from 2014-2016 and found that the national average sits at 4.3 percent.

Disturbingly, Rhode Island’s rate is 5.3 percent, putting the Ocean State among the top six states with the highest rates of diagnosed skin cancers, which include basal cell carcinoma, squamous cell carcinoma, melanoma and others. Ranked among states like Florida (7.1 percent), Washington, D.C. (5.8 percent), Connecticut (5.6 percent), Maryland (5.3 percent) and Vermont (5.3 percent), Rhode Island’s position on this list is concerning and potentially surprising to many.

However, what’s not surprising is that after a long winter, many Rhode Islanders take full advantage of outdoor activities like weekends at the beach, fishing trips, sailing, hiking and more. But the Ocean State is not unique in those activities compared to other states, so why is our rate so high? With a shortened sun exposure season of May through October, it’s surprising to see Rhode Island rank where it does. Perhaps it’s a simple explanation: We underestimate our risk due to the shortened summer season. Or, we aren’t as vigilant with our sunscreen use because we don’t live in the sunbelt states. Rhode Island also has one of the oldest populations in the nation, and sun exposure over time can add up detrimentally.

Regardless, skin cancer is the most common kind of cancer in the U.S. In fact, according to the American Academy of Dermatology, nearly 9,500 people are diagnosed every single day.

While all skin cancers are potentially serious, melanoma is the most severe. Stage four melanoma is often hard to cure with current treatments and the five-year survival rate is only about 15 to 20 percent. Luckily, skin cancers of all types can be avoided through prevention and early detection. Here are some things to keep in mind:

1) Know your risk factors. Anyone can get skin cancer, but there are certain risk factors to be aware of including having red or blonde hair, freckles, fair skin or a lot of moles. Your activities also put you in higher risk categories, such as the amount of time you spend outdoors, or if you live in or travel to tropical climates. Other risk factors include your family history of skin cancer, as well as your medications (e.g. those that make you sensitive to light).

2) Think carefully about sunscreen. Wearing sunscreen seems like a no-brainer, but how you apply it and how much you apply are worth a closer look. You should apply sunscreen 20 to 30 minutes before going outside and reapply every two hours, especially if you are sweating or get wet. You should also apply at least one ounce, or enough to fill a shot glass. Also, make sure to check the expiration date (most sunscreens last only two to three years) and use liberally, making sure to cover often-overlooked body parts like ears, hands, feet and underarms.

3) Say no to tanning beds—always. According to the Skin Cancer Foundation, people who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. To prevent melanoma risk, many argue that parental consent legislation would be useful, but this is not the path the state takes to keep cigarettes or alcohol out of the hands of kids, so why should it be for indoor tanning? Blue Cross & Blue Shield of Rhode Island supports legislation -- introduced by Representative Mia Ackerman and Senator Maryellen Goodwin -- that prohibits the use of tanning beds by anyone under 18 years of age. That legislation has been approved by the Rhode Island General Assembly and is now before Governor Raimondo.

4) Select the right summer accessories. It’s important to think carefully about your sunglasses, hats and other accessories – especially between 10 a.m. and 4 p.m. when the sun is the strongest. The best sun-safe clothing and hats are made of light-colored fabrics that are tightly woven. UV rays can also have damaging effects on your eyes. Look for wrap-around sunglasses with 99 or 100 percent UV absorption, which provide the best protection for not only your eyes, but for the delicate skin that surrounds them.

Even once you’ve mastered prevention, it’s important to factor in detection to catch potential issues early on. There are several free skin cancer screenings taking place this summer at Rhode Island beaches. They are open to the public and held in towns from Pawtucket to Newport. To view a list of screenings, visit this website. A good rule of thumb is to check your skin monthly and look for the following warning signs (easy to remember with the A, B, C, D, E rule). If you notice any of these irregularities, contact your doctor immediately.
• Asymmetry – do your moles have mismatched sides?
• Border – look for irregular or jagged edges.
• Color – check for inconsistent color throughout or discoloration.
• Diameter – moles larger than ¼ inch should be flagged to your doctor.
• Evolving – changes in color, shape or size are warning signs.
For more information on skin cancer, visit https://www.cancer.org/cancer/skin-cancer.html

Rhode Island is known for many great things, especially in the summer months: Our beaches, Del’s lemonade, quahogs, Pawsox games and much more— but let’s work together to ensure that skin cancer never becomes something we’re known for. With a focus on prevention and early detection, we can work collectively to spread the word about sun safety and the dangerous risks of skin cancer. Together, we can move forward to keep our communities healthy and enjoy many more sunny days ahead.

Gus Manocchia is executive vice president and chief medical officer at BCBSRI.