For all the joys it brings, the sun can be a dangerous thing, and dermatologists know this all too well.
When Vancouver broke records on June 28 with a high of 115 degrees, there was a 120 percent increase in heat-related ambulance dispatches. While many of those calls were to treat symptoms of heat exhaustion or heat stroke, Pacific Northwesterners are also at risk for a different sun-related affliction: melanoma.
“The Pacific Northwest is an area where there’s a very high incidence of melanoma — a very dangerous skin cancer,” said Dr. Viet Nguyen, a dermatologist at Vancouver Clinic Salmon Creek location, where he’s practiced for six years.
He said that while skin cancers tend to develop because of sun exposure over the years, melanoma in particular occurs more with intermittent exposures.
“That’s the culture we have here,” Dr. Nguyen, 39, said. “We get a little bit of sun and we scramble outside. That does make people more susceptible to developing melanoma.”
2525 N.E. 139th St., Vancouver.
Number of employees: There are three certified physician assistants and six physicians, including Dr. Nguyen, working in the dermatology department across The Vancouver Clinic’s Salmon Creek and Columbia Tech Center locations.
Bureau of Labor Statistics job outlook: Dermatology falls under the category of physicians and surgeons in the bureau’s Occupational Outlook Handbook. It’s a field forecasted to grow 4 percent through 2029. In the category of physicians that include dermatologists, the average salary in the Portland-Hillsboro, Ore.- Vancouver metropolitan area was $84.07 per hour or $174,860 per year, according to May 2020 data.
Dr. Nguyen sees anywhere between 25 to 30 patients a day. The vast majority of visits involve diagnosing skin cancers.
“It’s not so much acne or warts or something. It’s mostly seeing skin cancer,” he said.
But he doesn’t suggest just hunkering down inside forever to avoid getting sun burnt.
“I encourage people to get out. That’s part of life out here – getting outside. But protect yourself against the sun. Avoid using tanning beds; that can be dangerous too. Vitamin D is a concern for people and you can get Vitamin D through supplements,” he said. “But if you see something that’s growing, darkening or changing, let a physician know.”
The Columbian caught up with Dr. Nguyen to learn more.
Tell me about yourself.
I was born in Corvallis, Ore., and my parents were immigrants from Vietnam. I went to college and medical school at the University of Washington and did my training in dermatology in Michigan. I worked at a few places in the Seattle area, then Cleveland, then ended up coming back here six years ago. My wife and I are both physicians here at the clinic.
What was the job like during the pandemic? Did you see any changes in concerns from patients regarding skin care?
During the pandemic, we had a lot of concerns about keeping the patient safe. We didn’t know a lot about COVID-19 at the time, so we couldn’t risk having patients who were older or who have medical issues come into the clinic. Our IT team in the clinic developed a video capacity to see patients from home. There were many patients who had new rashes, and because the coronavirus manifests in the skin; we were there to answer questions if they had a problem that didn’t involve breathing problems and just involved the skin.
What are the skin issues related to COVID-19?
There are a lot of issues initially patients didn’t know were related to COVID-19. For example, people had discoloration to their toes. They may not have noticed it was anything unless someone who was familiar with COVID-19 looked and said yes, it’s potentially COVID. We sent information to urgent care providers. In the beginning we’d watch for blue toes or feet. We’d look for a widespread sudden rash on the body. We’d look for the lacy bruises that people would get on legs or arms. Or of course if they had a fever or cough, I’d raise the suspicion more. There’s not a lot anymore – we’ve got vaccines now.
As you know, we just endured a particularly powerful heat wave. Did you receive any calls? Can you talk about some of the dangers for people’s skin during these times?
Thankfully I did not get any calls. We emphasize sun safety to all our patients. We encourage them to have protection, whether that’s hats, sunglasses or long-sleeved clothing in addition to at least SPF 30 sunscreen, and to seek shade during the times between 10 a.m. and 2 p.m. to avoid the sun’s rays at their worst. We do this because the sun is a major contributor to skin cancer.
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Is there a best option for sun protection?
I get this question a lot. My personal preference is more permanent shade, so either being inside or wearing clothing that has protection built into it called UPF (ultraviolet protection factor) rating. Sunscreens are good, but they only last a couple of hours on the body before they run out of effectiveness. Typically, I’ll recommend use of mineral sunscreen with zinc or titanium oxide.
What really is the difference between say, SPF 50 and SPF 100?
Generally speaking, not much. There’s some small differences. We recommend at least 30. I tend to not recommend more than 50 unless people have some kind of medical condition. Part of that is because it’s hard to apply enough sunscreen to get the effectiveness that shows up on the bottle. People should use clothing, hats, glasses and a combination of things. Here’s a helpful tidbit: To cover your body, it takes two ounces of sunscreen every two hours. For a day at the beach that’s a whole bottle of sunscreen per person. People really don’t apply enough.
What are some of your hopes going forward?
I would love to see fewer cases of skin cancer as time goes on. I think I spend most of my time looking and finding and treating skin cancers. And nothing would make me happier than if people were able to protect themselves enough from the sun that they didn’t need to see me.