Need exposure protection recommendation--an interesting case...

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You could try a Whites Fusion Drysuit. Size L-XL would probably be about the best non-custom cut fit you could hope for, and at least that would have enough room even for extra thick undies for cold water diving. With thinner undies in the tropics, there would be lots of excess bag, but outer skin pulls it in, so it's not as bad as having extra bag with other suits.

For wetsuits, O'Neill is one of the brands that has decent suits for skinny people, but their sizes didn't work for you I take it. Camaro might be worth a try too (check out sierratradingpost.com). Or perhaps one of the Pinnacle Elastiprenes, a Medium Tall might not be a bad fit for you.

In general, seals at arm and leg cuffs help to minimize water exchange (I prefer fold-in or tuck-in seals), that is, less water warmed up by your body will flow out and be replaced by colder outside water as you move around. Seals are especially useful if the suit is a little too loose as loose suits trap more water inside that can whisk off body heat as it exchanges. You might even be able to get basic, fold-in neoprene seals custom installed on a suit if they do not come with the model you want - I've considered adding them myself (trick would be finding the thin, smooth neoprene in small quantities)...

If you have extra room in the torso area, add a hooded vest under the suit; they have the added benefit of stopping that unpleasant feeling of cold water trickling in through the neck seal, and it'll warm you within the water trapped in the main suit.
 
https://www.shearwater.com/products/teric/

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