Skin Cancer Survivors Who Are Sexual or Gender Minorities Face Steep Barriers to Care, Study Finds

Skin cancer is the most common malignancy in the United States, and for most patients a diagnosis marks the beginning of years of surveillance, follow-up appointments, and vigilant self-examination. But a new research letter published in the Archives of Dermatological Research suggests that the path through survivorship is not equally smooth for everyone. A team of dermatologists and data scientists from Emory University, UCLA, and Yale School of Medicine has turned a large national research dataset toward a question that has received surprisingly little attention: what stands between sexual and gender minority skin cancer survivors and the medical care they need? The study, led by first author Courtney A. Smith of the David Geffen School of Medicine at UCLA and the Department of Dermatology at Emory, with senior author Howa Yeung of Emory, was published on 30 September 2026 as part of volume 318 of the journal.

The investigation draws its power from an unusual and ambitious source: the All of Us Research Program, the National Institutes of Health’s effort to gather health data from one million or more people across the United States, with deliberate oversampling of groups that have historically been underrepresented in biomedical research. The researchers analyzed the program’s Controlled-Tier Dataset, release version 8.0, which combines participant-provided survey information with electronic health record data in a de-identified form accessible to approved researchers through the NIH Researcher Workbench. Because All of Us participants consented at enrollment to secondary research use of their survey and electronic health record data, the team could examine patterns of care access among skin cancer survivors who also identify as sexual or gender minorities, a population too small and too dispersed to study efficiently at any single medical center.

Why does this population warrant special scrutiny? The answer lies in a growing body of evidence suggesting that sexual and gender minority individuals may carry elevated dermatologic risk. A 2026 review by Irfan and Peebles in the JAAD Reviews series examined skin cancer prevalence and risk behaviors among sexual or gender minority individuals, adding to earlier concerns catalogued by Kratzer and colleagues in a sweeping 2024 Cancer paper on cancer in people who identify as lesbian, gay, bisexual, transgender, queer, or gender-nonconforming. Behavioral risk profiles matter here: patterns of indoor tanning use, ultraviolet exposure, and other skin-cancer-related behaviors have been reported to differ by sexual orientation and gender identity, and some subgroups appear to bear disproportionate exposure. If risk is elevated, then equitable access to dermatologic surveillance and treatment becomes a matter of basic cancer-control equity, not merely a question of comfort or courtesy in the clinic.

The barriers the study set out to measure are not hypothetical. Prior work has documented that transgender people in particular frequently avoid healthcare altogether because they anticipate discrimination, a finding established by Kcomt, Gorey, Barrett, and McCabe in a 2020 analysis published in SSM – Population Health. That study framed the problem as a call to create trans-affirmative care environments, noting that avoidance driven by expected mistreatment can delay screenings, interrupt chronic disease management, and allow treatable conditions to progress. For a skin cancer survivor, whose prognosis depends heavily on early detection of recurrences and new primary tumors, any systematic tendency to postpone or skip dermatologic follow-up carries measurable clinical consequences. Delayed surveillance can mean that a thin, highly curable melanoma is instead caught at a thicker, more dangerous stage.

Financial pressure compounds the problem. In 2023, Supapannachart, Chu, Chen, and Yeung, publishing in this same journal, analyzed population-based survey data from 2011 to 2018 and documented the burden of financial toxicity in skin cancer care in the United States. Financial toxicity, the term oncologists use for the economic strain a cancer diagnosis imposes on patients and households, encompasses out-of-pocket costs for surgery and pathology, copayments for frequent surveillance visits, and the income lost to time away from work. Skin cancer survivors typically require lifelong monitoring, so these costs recur year after year. When minority stress, anticipated discrimination, and structural barriers to insurance coverage intersect with this recurring financial burden, the cumulative effect on care-seeking behavior can be substantial, particularly for patients already navigating precarious employment or unstable housing at higher rates than the general population.

Geography adds yet another layer. McKay, Lampe, Barbee, Prasad, and Gonzales reported in 2024 in Public Policy & Aging Report on an evidence-based framework for supporting older LGBTQ+ adults in rural communities, drawing on the LGBTQ+ Social Networks, Aging, and Policy Study. Their findings highlight how rural sexual and gender minority elders often contend with sparse local healthcare infrastructure, long travel distances to specialized care, and smaller, more tightly knit social networks in which disclosure of one’s identity carries real social risk. Because skin cancer incidence rises steeply with age and cumulative sun exposure, older rural survivors who are also sexual or gender minorities sit at the intersection of several vulnerability factors at once. The All of Us program’s national reach, including participants from regions where dedicated LGBTQ+ health services are scarce, makes it a fitting instrument for detecting these compounded disparities.

Methodologically, the study is a secondary analysis of de-identified controlled-tier data, a design that allowed the investigators to assemble a cohort of skin cancer survivors identified within the All of Us program and to compare patterns of reported barriers to medical care across sexual orientation and gender identity groups. The research letter format means the team reported a focused analysis rather than an exhaustive treatise, but the underlying approach reflects a broader shift in how health disparities research is conducted. Instead of recruiting patients through clinics, where the sample is already filtered by who managed to obtain care, population-level datasets capture people across the full spectrum of healthcare engagement, including those who have fallen out of the system entirely. Survey-based measures of access barriers, paired with electronic health record indicators of care utilization, offer complementary windows on the same phenomenon.

The ethical architecture of the work is also worth noting. The All of Us program operates under a centralized Institutional Review Board approval at the National Institutes of Health, which covers use of controlled-tier data, and the authors’ institutions determined that this secondary analysis did not meet the definition of human subjects research under federal regulations, requiring no additional IRB review. All participants had provided written informed consent for secondary research use of their data at enrollment. The study received no specific funding, and the authors disclosed relevant consulting and advisory relationships typical of academic dermatologists, including Dr. Yeung’s grant support from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and various industry sources, none of which funded this particular study.

What makes this research letter resonate beyond dermatology is the framework it implies for cancer survivorship research as a whole. Sexual and gender minority adults are increasingly visible in cancer statistics, thanks in part to the 2024 Cancer synthesis by Kratzer and colleagues, yet survivorship care, the phase of medicine where patients spend the majority of their years after diagnosis, remains understudied in these populations. The barriers documented in adjacent literatures, from anticipated discrimination to financial toxicity to rural isolation, do not disappear once a tumor is removed; if anything, the demands of long-term surveillance raise the stakes. A survivor who avoids the dermatologist because the intake form offers no room for their identity, or because the nearest affirming provider is three hours away, or because the copay competes with rent, is a survivor whose next skin cancer may be found late.

The study’s data are available to authorized researchers through the All of Us Researcher Workbench, and the authors acknowledge that the program’s participants made the work possible. As the All of Us dataset grows with each release, analyses like this one will gain statistical power to dissect barriers with finer granularity, distinguishing, for example, between cost-related delays, discrimination-related avoidance, and transportation or insurance obstacles. For clinicians, the immediate lesson is practical: dermatology practices that serve skin cancer survivors should expect sexual and gender minority patients in their panels and should build intake, billing, and follow-up systems that do not give those patients additional reasons to disengage. For policymakers, the study adds dermatologic survivorship to the list of domains where minority stress translates into measurable healthcare inequity, and where relatively modest interventions, from inclusive electronic health record fields to tele-dermatology outreach in rural areas, could meaningfully narrow the gap.

Subject of Research: Barriers to medical care among sexual and gender minority skin cancer survivors in the United States

Article Title: Barriers to medical care among sexual and gender minority skin cancer survivors

Article References: Smith, C. A., Ohamadike, C., Deitelzweig, C., Nock, M. R., Cohen, J. M., & Yeung, H. (2026). Barriers to medical care among sexual and gender minority skin cancer survivors. Archives of Dermatological Research, 318(1), Article 499. https://doi.org/10.1007/s00403-026-04970-4

Image Credits: AI Generated

DOI: 10.1007/s00403-026-04970-4

Keywords: skin cancer, sexual and gender minority, healthcare barriers, dermatology, cancer survivorship, All of Us Research Program, health disparities, financial toxicity, transgender health, melanoma surveillance, minority stress, rural health