CHARLESTON, W.Va. (McClatchy-Tribune Information Services) -- As the hottest months of summer approach, dermatologists say people need to take extra precautions when working and having fun in the sun.

According to the , 1 million cases of skin cancer were diagnosed in 2008.

"We see a lot of it," said Dr. Kimberly Skaff, a Charleston-based dermatologist. "We see more this time of year just because people pay more attention to their skin in the summer."

There are three basic types of skin cancer. Two of them, basal cell carcinoma and squamous cell carcinoma, are the most common and least dangerous.

But melanoma, which makes up just 3 percent of skin cancer cases, is responsible for more than 75 percent of skin cancer deaths, according to the American Cancer Society.

It's also the most common form of skin cancer among young adults and the second-most common among adolescents -- though like most skin cancers, it is highly treatable if detected early.

Dermatologists say the easiest way to identify possible melanoma is to use the ABCDE danger signs:

-- Look for any spot or sore on the skin that is Asymmetrical.

-- Look for an irregular or poorly defined Border on the spot.

-- Another sign is Color variation on the skin. Colors can range anywhere from red, white, blue to black, tan and brown.

-- Carefully inspect the Diameter of the spots. Melanomas are usually larger than a pencil eraser. It's also important to take note of any new moles, especially if they itch or bleed.

-- If the spot Evolves or changes in any way, it's essential to see a doctor.

The typical characteristics associated with basal cell carcinoma are shiny bumps or nodules that are translucent, as well as open sores that bleed or ooze and remain open for three or more weeks.

Patients with squamous cell carcinoma typically have a wartlike growth that occasionally bleeds and crusts, or a persistent, scaly red patch with irregular borders.

Skaff said she sees and treats a lot of nonmelanoma skin cancer, which also is less likely to spread to other parts of the body.

Up to 90 percent of skin cancer is caused by the sun's ultraviolet rays. The World Health Organization estimates that more than 65,000 people worldwide die from too much sun each year, mostly from malignant skin cancer.

To combat that, liberal use of sunscreen is recommended. But some sunscreens are more effective than others.

Dr. Roxann Powers, a dermatologist and faculty member at West Virginia University's Health Sciences Center, said that sunscreens that protect both UVA and UVB rays are best. She also recommends looking for sunscreen with zinc or titanium, which reflects the rays. Sunscreens with SPF 15 are usually not enough, she said. She recommends a sunscreen with at least SPF 30.

Powers also said to keep applying the sunscreen every two hours, especially if it's been exposed to water, as it can lose its efficacy.

Of course, there's no good substitute for staying under an umbrella or a seat in the shade.

Symptoms of skin cancer may not appear overnight and in some cases can take more than a few months to present themselves.

"You would be shocked how many people would come in and not even know the cancer was there," Skaff said.

But over the past few years it's not just the sun that can be harmful.

Dermatologists are concerned with the growing mindset that tanning beds are safer than tanning in the sun.

"People get a false sense of security if they use the tanning beds," Skaff said. "They are just as dangerous as natural sunlight. My prediction is that in the future they could be more dangerous."

A study published in the March issue of the American Journal of Preventive Medicine found that the Charleston area has the highest ratio of tanning salons to population.

The top way to prevent skin cancer is to raise awareness, Skaff said. While some people have not gotten the message yet, she said she's begun to see an improvement in awareness.

"The incidents have been increasing," she said. "But people are becoming more aware ... it's going to take a decade or two for increased awareness and decreased occurrence to happen."

Still, she is encouraged by parents who she sees taking the necessary precautions to prevent skin cancer in their young children, though she added that they are not always protecting themselves.

Copyright (C) 2009, The Charleston Gazette, W.Va.