They don’t call it the Sunshine State for nothing. Floridians get to soak up the sun year-round, but that exposure to harmful UV rays also comes with consequences. Prevention magazine reported that Florida has the highest rate of skin cancer in the U.S., according to a survey by Blue Cross Blue Shield (BCBS).

BCBS surveyed 9 million of its insured members who had been diagnosed with skin cancer between 2014 and 2016 and found that Florida had the highest rate of skin cancer at 7.1 percent. People living in eastern states tend to be more prone to skin cancer, and diagnoses are more common among women.

Here are the 20 states with the highest rates of skin cancer:

1. Florida: 7.1 percent
2. Washington, D.C.: 5.8 percent
3. Connecticut: 5.6 percent
4. Maryland: 5.3 percent
5. Rhode Island: 5.3 percent
6. Vermont: 5.3 percent
7. North Carolina: 5.2 percent
8. New York: 5 percent
9. Massachusetts: 5 percent
10. Colorado: 5 percent
11. Arizona: 5 percent
12. Virginia: 5 percent
13. Delaware: 4.8 percent
14. Kentucky: 4.7 percent
15. Alabama: 4.7 percent
16. New Jersey: 4.7 percent
17. Georgia: 4.7 percent
18. West Virginia: 4.5 percent
19. Tennessee: 4.5 percent
20. South Carolina: 4.4 percent

It may come as a surprise that sunny California doesn’t make the top 20, and Hawaii is the state with the lowest rate of skin cancer at 1.8 percent. Prevention magazine explains that this could be due to the large population of senior citizens in Florida and the fact that the risk of melanoma, a rare but deadly type of skin cancer, increases with age. People living in regions with higher altitudes also face a greater risk of skin cancer due to the thinner atmosphere and greater exposure to UV radiation, which explains why Colorado is in the top 10.

The good news is that the technology used to detect skin cancer is improving, and researchers hope that AI can soon be incorporated into more skin cancer screenings. To reduce your risk, be sure to wear SPF 30+ sunscreen when you know you’ll be spending time outside, and don’t forget to reapply it every two hours. 

[h/t Prevention]