Decision Boundary-aware Generation for Long-tailed Learning

Long-tailed class distributions are pervasive in multi-class medical datasets and pose significant challenges for deep learning models which typically underperform on tail classes with limited samples. This limitation is particularly problematic in medical applications, where rare classes often correspond to severe or high-risk diseases and therefore require high diagnostic accuracy. Existing solutions-including specialized architectures, rebalanced loss functions, and handcrafted data augmentation-offer only marginal improvements and struggle to scale due to their limited and largely deterministic variability. To address these challenges, we introduce a diffusion-model-driven synthetic data augmentation pipeline tailored for medical long-tailed classification. Our approach features a novel inpainting diffusion model combined with an Out-of-Distribution (OOD) post-selection mechanism to ensure diverse, realistic, and clinically meaningful synthetic samples. Evaluated on the ISIC2019 skin lesion classification dataset, one of the largest and most imbalanced medical imaging benchmarks, our method yields substantial improvements in overall performance, with particularly pronounced gains on tail classes with more than $28\%$ improvement on the class with the fewest samples. These results demonstrate the effectiveness of diffusion-based augmentation in mitigating long-tail imbalance and enhancing medical classification robustness.

Long-tailed distributions are common in real-world recognition tasks, where a few head classes have many samples while most tail classes have very few. Recently, fine-tuning foundation models for long-tailed learning has gained attention due to their excellent performance. However, most existing methods focus solely on mitigating long-tailed distribution bias while overlooking concept confusion caused by the long-tailed distribution. In this paper, we study this problem and attribute it to the mutual exclusivity of single-label supervision under long-tailed distributions, which suppresses feature sharing among related classes and amplifies the dominance of head classes, leading to disrupted inter-class discriminability. To address this, we propose CUE, Concept-aware mUlti-label Expansion, which introduces multi-label concept signals to preserve disrupted inter-class relationships. Specifically, CUE constructs concept sets by (i) extracting instance-level visual cues from zero-shot CLIP and (ii) generating class-level semantic cues with LLM; the two cues are incorporated via separately weighted Binary Logit-Adjustment (BLA) auxiliary losses and jointly optimized with the baseline Logit-Adjustment (LA) loss. Experiments on several long-tailed benchmarks, CUE achieves balanced and strong performance, surpassing recent state-of-the-art methods. Code is available at: https://github.com/zhangruichi/CUE.

Adversarial training under long tailed distributions suffers from a dual imbalance: the class imbalance skews the training objective toward head classes, and the adversarial inner maximization may further amplify this bias. Existing methods mitigate this issue by correcting class priors or adapting class wise robust supervision, yet they treat each class in isolation and fail to identify which boundaries drive long tailed collapse. We propose a Confusion Geometry Rebalancing method (CGRm) for long tail adversarial training, a plug in framework that leverages directed robust errors as training signals. CGRm leverages periodic robust evaluations to derive source class loss weights, class wise robust coefficients, and a directed confusion geometry graph. The method then couples feedback weighted robust optimization with graph guided margin correction, thereby boosting the robustness of vulnerable classes and sharpening the critical boundaries that drive long tailed performance degradation. Experiments on long tailed benchmarks show that CGRm achieves consistent robust performance gains over existing methods, with ablations validating the contribution of each component. We provide the code in the supplement.