MedTokenBudget: Lesion-Preserving Token Routing for Dermoscopic Image Classification

Most token reduction methods for Vision Transformers seek favorable tradeoffs between accuracy and efficiency by pruning, merging, or pooling patch tokens. REDI (Relevance for DINOv3 Token Reduction) studies this question through a controlled supervised reference: how should a fixed token budget be allocated across patches for image classification? REDI quantizes final block DINOv3 patch representations into a visual vocabulary and derives class conditioned corpus scores using supervised TF-IDF over visual words. For each validation image, the ground truth class selects a row of the TF-IDF table, and four transformed views produce a TF-IDF map aligned to a reference center crop. A separate dense pass on the same crop provides an attention map. After independent min max normalization, their elementwise product defines the REDI score. A fixed keep, merge, and compress operator then uses score rank to assign patch roles and score magnitude to weight merging and compression. With precomputed REDI scores, a frozen DINOv3 ViT-B/16 backbone, and the same linear classifier used for dense evaluation, the operator reduces the sequence length from 201 to 107 tokens, a 46.8% sequence reduction. The REDI variant based on incoming attention mass achieves 84.706% Top-1 accuracy on ImageNet-1K, compared with 83.514% for the dense baseline, 82.634% for incoming attention mass alone, and 81.796% for supervised TF-IDF alone. The same corpus term also improves reduced classification for three alternative attention formulations relative to their attention only counterparts. Together, these controlled comparisons indicate that class specific corpus statistics and image specific attention provide complementary signals for patch ranking in this setting.

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.

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.