SALT LAKE CITY — Hours in the sun with fair skin left Hillary Fowler with painful blisters and freckles instead of a coveted bronzed complexion.
"I don't know what it is about my skin. The sun just really doesn't like me," she said.
Everyone should be wary of getting too friendly with the sun, especially in Utah. The Beehive State has the highest number of deadly melanoma cases in the country.
According to the Utah Cancer Registry, Utah's melanoma rate is 61 percent higher than the national average and the mortality rate is 30 percent higher.
"We're definitely in the No. 1 spot," said Lynne Nilson, spokeswoman with the Utah Department of Health. "We are higher than some of the traditionally sunniest states like Arizona, California, Hawaii and Florida."
Nilson, director of the Utah Cancer Control Program, said Utah's high elevation plays a major part in high number of melanoma cases. And the sun reflects off Utah's diverse landscape of sand, water, snow and ice.
"Utahns spend a lot of time outside," she said. "We recreate. We're outside with our families. We're just outside all the time."
Fowler recalled the worst sunburn she's ever had. She spent the day boating with no sunscreen or cover. She came home with blisters more than an inch in diameter.
"That was five or six years ago and I still have a line of freckles all the way down from where I got burned," she said. "I'm still seeing the lines from that. So that's kind of scary."
Friends and family have warned Fowler about protecting her fair skin. Her grandmother recently had melanoma. The chunk removed from the top of her ear is a constant reminder to Fowler of the need for sunscreen.
"That's my future," she said. "It terrifies me, like seeing what could actually happen."
"Anyone can get melanoma — anybody," Nilson said. "Young people, older people. It doesn't matter your race, your ethnicity. Everyone can get skin cancer."
The acting U.S. surgeon general is calling on Americans to cover up and stay out of the sun.
"The rates of skin cancer in our nation are increasing, creating a serious public health concern we cannot ignore," Boris D. Lushniak said in a statement.
He recommends communities provide shade in recreational areas, that businesses increase sun protection for outdoor workers, and that health providers teach the public about the importance of using sun protection.
It was all advice echoed by Nilson.
"Limit the time when the UV light is the strongest," she said.
For Utah, that means covering up between the hours of 10 a.m. and 4 p.m. when ultraviolet rays are the strongest.
"Definitely wear sunscreen, no doubt about it," Nilson said. "Wear a hat, wear long-sleeved shirts, wear long pants. And definitely limit indoor tanning."
In 2011, Nilson said about 12 percent of teens under the age of 18 reported using an indoor tanning bed. A new Utah law passed in 2012 requires children under 18 to have a parent present in order to use a tanning bed and the parents must also provide written consents for each visit.
Nilson said in 2013, the number of tanning bed users among teens dropped to 7 percent. But there's still room for improvement and a change of the state's idea of beautiful skin.
"Every single time you have a suntan, your skin is darker than it normally is and you are causing damage to your skin."
Nilson stressed the importance of educating parent so they can protect their children, who often spend more time playing in the sun than adults who are working.
Fowler said she now has a wide-brimmed hat that she wears outside to shield her face and shoulders and she is much more conscious about using sunscreen.
If given the opportunity, she tells others to "wear sunscreen and stay in the shade." She said she's also given up her dream of bronzed skin.
"I get super sunburned and endure the pain, but I don't get anything good out of it," she said.