Explainable Continuous-Time Mask Refinement with Local Self-Similarity Priors for Medical Image Segmentation

Quantifying wound tissue composition is essential for monitoring chronic ulcer progression and guiding treatment decisions. However, pixel-level annotations are costly, and multi-tissue wound datasets remain scarce, particularly for neglected diseases such as leprosy. We introduce LUTSeg, a longitudinal chronic ulcer dataset comprising 141 images from 39 patients with wound masks and five tissue categories annotated by five expert clinicians, including a multi-expert gold-standard subset for inter-rater agreement analysis. To establish an initial benchmark for LUTSeg, we further propose TiSage, a semi-supervised tissue segmentation framework that integrates multi-scale semantic priors from a frozen medical vision-language model within a teacher-student architecture. We evaluate TiSage on LUTSeg and DFUTissue, showing improvements over supervised and semi-supervised baselines in most low-label settings. Code & data: https://github.com/carlosh93/TiSage

Deep learning models for diabetic foot ulcer (DFU) segmentation routinely report high accuracy, but they are almost always trained and tested on the same dataset, leaving their behaviour on data from a different clinical source largely unmeasured. We benchmark three representative segmentation architectures -- U-Net and DeepLabV3+ (convolutional) and SegFormer-B2 (Transformer) -- under an identical, leakage-screened protocol: training on the combined FUSeg/AZH wound data and evaluating, without fine-tuning, on two independent external datasets (DFUC2022 and Medetec). All models achieve strong in-domain performance (Dice 0.80--0.83) but degrade substantially across datasets. The degradation is, however, architecture-dependent: SegFormer-B2 generalizes best on both external sets (DFUC2022 Dice 0.557, Medetec Dice 0.786), outperforming both convolutional models, while the more complex DeepLabV3+ generalizes worse than the simpler U-Net. Per-image failure analysis on 2,160 images across both external test sets confirms that SegFormer-B2 produces the fewest catastrophic failures on DFUC2022 (31.1%), compared with U-Net (38.5%) and DeepLabV3+ (43.0%). The consistent ranking across two independent external sources, confirmed by Wilcoxon signed-rank tests (p < 0.001 on both datasets), indicates that architecture family, not model complexity, drives cross-hospital generalization.

Recent segmentation models have demonstrated promising efficiency by aggressively reducing parameter counts and computational complexity. However, these models often struggle to accurately delineate fine lesion boundaries and texture patterns essential for early skin cancer diagnosis and treatment planning. In this paper, we propose MambaLiteUNet, a compact yet robust segmentation framework that integrates Mamba state space modeling into a U-Net architecture, along with three key modules: Adaptive Multi-Branch Mamba Feature Fusion (AMF), Local-Global Feature Mixing (LGFM), and Cross-Gated Attention (CGA). These modules are designed to enhance local-global feature interaction, preserve spatial details, and improve the quality of skip connections. MambaLiteUNet achieves an average IoU of 87.12% and average Dice score of 93.09% across ISIC2017, ISIC2018, HAM10000, and PH2 benchmarks, outperforming state-of-the-art models. Compared to U-Net, our model improves average IoU and Dice by 7.72 and 4.61 points, respectively, while reducing parameters by 93.6% and GFLOPs by 97.6%. Additionally, in domain generalization with six unseen lesion categories, MambaLiteUNet achieves 77.61% IoU and 87.23% Dice, performing best among all evaluated models. Our extensive experiments demonstrate that MambaLiteUNet achieves a strong balance between accuracy and efficiency, making it a competitive and practical solution for dermatological image segmentation. Our code is publicly available at: https://github.com/maklachur/MambaLiteUNet.