RABC-Net: Reliability-Aware Annotation-Free Skin Lesion Segmentation for Low-Resource Dermoscopy

Reliable skin lesion segmentation and classification are central to dermoscopic computer-aided diagnosis. Existing multi-task frameworks couple the two tasks architecturally without clinical knowledge, while knowledge-injecting approaches rely on the macroscopic ABCD rule, which was not designed for dermoscopy. Dermoscopic diagnosis is grounded in Pattern Analysis, a microscopic framework structured around dermoscopic features. We propose MDSkin-Net, which incorporates cue-level Pattern Analysis priors into a hybrid CNN-Transformer architecture. At its core is a Pattern Analysis-Guided Attention Module (PAGAM) comprising three priors motivated by distinct dermoscopic cues: an improved Efficient Channel Attention (iECA), a Multi-Scale Spatial Attention (MSSA), and a Biased Asymmetry Attention (BAA). We further introduce a multi-scale spatial alignment regularization (MSAR) that uses the segmentation ground-truth mask as hierarchical soft supervision, confining the classification head to lesion-localized evidence and coupling both task pathways through a shared spatial prior. Trained exclusively on the ISIC 2017 training split without external dermoscopy data, the MDSkin-Net ensemble transfers robustly under zero-shot evaluation, reaching a Dice Similarity Coefficient (DSC) of 92.38% and a melanoma AUC of 97.84%on PH2, and a DSC of 88.92% on the ISIC 2018 Task 1 test set. On the in-domain ISIC 2017 benchmark, the ensemble attains a mean Area Under the Curve (AUC) of 91.60% across the two classification tasks (melanoma and seborrheic keratosis vs. rest), and a DSC of 84.72% for segmentation. Classification remains competitive with baselines; in-domain segmentation trails single-task specialists, yet the proposed priors and alignment regularization yield representations that generalize consistently across cohorts of different scales.

Handcrafted preprocessing is widely employed in automated dermoscopic analysis to suppress imaging artifacts and enhance lesion visibility. Nevertheless, its actual contribution to modern real-time models remains unclear, particularly when evaluation protocols do not adequately control correlations among images of the same lesion. This study presents a leakage-controlled, lesion-disjoint evaluation of dermoscopic preprocessing and augmentation for joint multi-class lesion classification and instance segmentation using a fixed nano-scale YOLO26 segmentation model (YOLO26n-seg). From HAM10000 (10,015 images), quality control yields 10,013 valid image-mask pairs from 7,468 unique lesions, partitioned into mutually exclusive sets by lesion identity. With the architecture, resolution, training budget, and evaluation protocol held fixed, we compare minimally processed images plus online augmentation against offline class balancing, DullRazor-CLAHE preprocessing, and raw-processed hybrid views, over three random seeds. On the lesion-disjoint test set, the raw baseline achieves a mask mAP$_{50:95}$ of $0.5636 \pm 0.0234$, a Dice score of $0.9356 \pm 0.0024$, and a macro-F1 score of $0.6917 \pm 0.0202$. Offline augmentation does not improve the mean performance, while the combined and hybrid strategies reduce both class-aware segmentation and classification accuracy. At only 2.69 million parameters, the model runs at approximately 50 frames per second. Under a leakage-controlled, lesion-disjoint protocol with all non-input factors held fixed, minimally processed dermoscopic images combined with standard online augmentation deliver a better accuracy-efficiency trade-off than increasingly complex deterministic preprocessing, which yields no consistent joint benefit across three seeds on HAM10000.

Accurate skin lesion classification can benefit from lesion segmentation masks, but requiring masks or an auxiliary segmentation model during inference reduces clinical practicality and increases computational complexity. This work introduces Privileged Lesion-Context Relational Distillation (PLCRD), a teacher-student framework that exploits lesion masks exclusively during training while preserving image-only inference. The privileged teacher jointly analyzes the original dermoscopic image and its mask-guided lesion region to learn lesion-specific and contextual diagnostic representations. An image-only student is then trained through complementary knowledge-transfer mechanisms that convey the teacher's diagnostic distribution, lesion-focused attention, inter-lesion relational geometry, and lesion-context structure. PLCRD decomposes deep representations into lesion and contextual embeddings and transfers their relational organization through inter-lesion similarity alignment, lesion-context affinity matching, separation regularization, and class-aware relational learning. This formulation avoids direct feature matching between heterogeneous teacher and student architectures and enables the student to internalize mask-informed diagnostic structure without accessing masks at deployment. The framework was evaluated on HAM10000 using lesion-disjoint data partitioning and externally validated on ISIC 2018 without retraining. PLCRD achieved a lesion-level macro-F1 of 0.773 +/- 0.018, balanced accuracy of 0.764 +/- 0.023, and macro-AUROC of 0.976 +/- 0.002 on HAM10000, together with a macro-F1 of 0.732 +/- 0.008 on ISIC 2018. The results indicate that privileged lesion annotations can be transformed into transferable relational knowledge, yielding a practical and interpretable approach to mask-free skin lesion classification.