Review
Skin cancer and skin cancer risk behaviors among sexual and gender minority populations: A systematic review

https://doi.org/10.1016/j.jaad.2020.02.013Get rights and content

Background

Individuals of sexual and gender minorities may have different lifetime risk of skin cancer and ultraviolet radiation exposure than heterosexual persons.

Objective

To systematically review the prevalence of skin cancer and behaviors that increase risk of skin cancer among sexual and gender minority populations.

Methods

We performed a systematic literature review in PubMed/MEDLINE, Embase, Cochrane, and Web of Science, searching for articles through October 18, 2019, that investigated risk of skin cancer and behaviors among sexual and gender minority populations.

Results

Sexual minority men have a higher lifetime risk of any skin cancer (odds ratio range: 1.3-2.1) and indoor tanning bed use (odds ratio range: 2.8-5.9) compared with heterosexual men, whereas sexual minority women may use indoor tanning beds less frequently than heterosexual women and do not have an elevated risk of lifetime history of skin cancer. Gender-nonconforming individuals have higher lifetime prevalence of any skin cancer compared with cisgender men.

Limitations

Most variables rely on self-reporting in their original studies.

Conclusions

Sexual minority men disproportionately engage in use of indoor tanning beds, which may result in increased lifetime risk of skin cancer. Recognition of this risk is important for providing appropriate screening for patients in this population.

Section snippets

Methods

This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.10

Selection of studies

Our initial search identified 4508 articles. Of those, 4311 were excluded based on the title, and an additional 145 were excluded after review of the title and abstract. A total of 52 full-text articles were ultimately reviewed for inclusion, with 12 meeting inclusion criteria for our study. Two additional studies written by our research group that are currently in press were added, resulting in 14 total articles being included in our study sample (Fig 1).

Of the studies included, 2 included

Discussion

The results of this systematic review show that there are differences in the prevalence of skin cancer and behaviors that increase risk of skin cancer among sexual and gender minorities, particularly among SMM. SMM have increased risk of skin cancer prevalence and disproportionately engage in use of indoor tanning beds. The single study that provided data on photoprotective behaviors of women suggests that although SMW may have a slightly increased risk of sunburns, SMW use tanning beds less

Conclusion

SMM have a higher prevalence of both skin cancer and indoor tanning bed use compared with heterosexual men, which is likely due to unique community pressures and appearance ideals that face this community. A combination of outreach, education, and public health initiatives targeted at reducing indoor tanning bed use among SMM may reduce the elevated risk of skin cancer currently seen in this population.

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    Funding sources: None.

    Conflicts of interest: None disclosed.

    IRB approval status: This study was deemed IRB exempt by the Partners Institutional Review Board as it is a review that utilizes publicly available data.

    Reprints not available from the authors.

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    © 2020 Published by Elsevier on behalf of the American Academy of Dermatology, Inc.