Experiences of Full Body Skin Examinations among Sexual and Gender Minority Patients in Dermatology: A Qualitative...

Sexual and gender minority (SGM) patients experience disproportionate skin cancer risk and barriers to preventive dermatologic care access relative to non-SGM counterparts. Yet SGM may be deterred from the full body skin exam (FBSE) for screening due to fear of stigma surrounding their bodies. There is a dearth of qualitative research about SGM patients' perceptions of the FBSE. To address this gap, we surveyed 175 SGM-identifying patients; 161 provided qualitative responses describing whether their sexual or gender identity (SOGI) influences their decision to undergo a FBSE and why. We identified pervasive themes of discomfort, fear of clinician discrimination (anticipatory stigma), and prior discriminatory experiences. The 69.6% of participants who reported their SOGI did not influence their decision to undergo a FBSE most commonly described enduring the FBSE for health benefits despite significant discomfort. Among the remaining 30.4% of participants, discomfort was substantial enough to influence their decision to undergo a FBSE, with 75.5% citing fear of clinician discrimination as a cause for hesitation. Forty-six participants provided specific recommendations to improve the FBSE experience for SGM, including: providing gowns and chaperones, visible displays of allyship (e.g. flags), offering SGM-specific care (e.g. for top surgery scars), affirming communication (correct pronoun use and avoiding anatomy assumptions), eliciting trauma history, and continuous consent throughout the exam. Across responses, a unifying theme was that clinicians' lack of understanding about SGM experiences contributed substantially to patient discomfort. Our findings suggest that fear of clinician discrimination and past discriminatory experiences may discourage some SGM patients from undergoing FBSEs, which may exacerbate existing health disparities burdening this population. These findings underscore the need for SGM-specific education and bias reduction in dermatologic training.