Skin Lesion Classification

Artificial intelligence (AI) has advanced at a rapid pace in recent years. Initially, breakthroughs in large language models caught widespread attention. However, recent generations of frontier AI models have adopted multimodal capabilities as a first class citizen, with vision capabilities being central to that. In this paper, we evaluate three recently released models on the task of diagnosing dermatological conditions from patient-submitted images. The models chosen are at the low to mid tier in terms of pricing and thus represent a floor on current AI capabilities, not a ceiling. We evaluate AI performance relative to a panel of three certified dermatologists, who grade each image, and we present four interesting findings. Firstly, depending on the metric, the tested AI models are either on par or slightly trail humans in terms of inter-clinician agreement. Secondly, we find that asking AI models for a confidence rating produces poorly calibrated answers, meaning use of confidence thresholds should not be relied upon in a clinical setting. Thirdly, the effect of providing additional patient metadata is strongly model-specific, with one of the three models degrading on every metric considered. Finally, model cost is not predictive of performance. The best-performing model we tested costs on average $0.0045 per case.

High-frequency ultrasound (HFUS) enables noninvasive visualization of superficial skin structures, but automated skin-layer analysis is limited by the scarcity of densely annotated data. Existing real HFUS datasets commonly provide annotations for superficial targets such as the epidermis and subepidermal low-echogenic band (SLEB), while dense labels for deeper structures such as dermis, subcutaneous tissue, fascia, and muscle are rarely available. We propose a physics-guided synthetic HFUS generation framework for skin layer segmentation. The framework constructs multilayer acoustic skin phantoms, assigns layer dependent acoustic properties, and uses k-Wave simulation to generate paired synthetic HFUS images, dense layer masks, and simulation metadata. To evaluate whether the generated data provide transferable supervision, we use it for downstream segmentation pretraining and fine-tune the models on real Mendeley HFUS data. Synthetic pretraining followed by real fine-tuning achieved real-domain performance comparable to real-only training and improved mean Dice/IoU in three of four evaluated trainable architectures. These results suggest that physics-guided synthetic HFUS images contain transferable anatomical and textural cues for real-domain skin layer segmentation, although further reduction of the synthetic-real appearance gap is needed to enable greater gains. The code and data are available at: https://github.com/Finn-02/synthetic-hfus-skin-layer-segmentation.

Early diagnosis of melanoma is critical for improving patient survival rates. However, accurately distinguishing melanoma from other skin lesions remains a significant clinical challenge due to the high visual similarity among lesion types and variability in image acquisition conditions. Artificial intelligence, particularly machine learning, has emerged as a promising tool to support dermatological diagnosis by automating feature extraction from medical images. Among the available approaches, convolutional neural networks (CNNs) have demonstrated strong performance in image classification tasks, making them well-suited for analyzing both dermatoscopic and histopathological images, given their ability to capture hierarchical visual patterns relevant to lesion characterization. Nevertheless, despite numerous pre-trained CNN architectures having been proposed, selecting the most appropriate one for a given imaging modality remains an open challenge. In this study, we evaluate pre-trained convolutional neural networks (CNNs) for skin lesion classification using dermatoscopic and histopathological image datasets. Experiments were conducted on the HAM10000, ISIC 2018, and CR-AI4SkIN datasets, evaluating the ResNet50, VGG16, VGG19, MobileNet, and InceptionV3 architectures under the same training protocol. The experimental evaluation showed that the models achieved accuracies ranging from 71% (InceptionV3 on ISIC 2018) to 84% (ResNet50 on HAM10000) on dermatoscopic images. For histopathological images, accuracies ranged from 72% (VGG19) to 83% (ResNet50) on the CR-AI4SkIN dataset. The results demonstrate that model performance differs between dermatoscopic and histopathological image modalities, showing that architectures exhibiting similar performance on dermatoscopic images exhibit different performance on histopathological data.

Segmenting bruises is a challenging task in medical imaging due to limited data and annotations, diffuse boundaries, and highly variable appearance. In this work, we propose BruNet, a segmentation framework that combines a ViT-based visual encoder (a self-supervised DINOv3 or a pretrained LingBot-Vision backbone) with a SAM-based mask decoder. BruNet is trained on the HAM10000 skin lesion dataset and evaluated on a separate bruise dataset without additional fine-tuning. Although a small number of prior studies have explored machine learning and computer vision for bruise analysis, existing work has primarily focused on detection, classification, or colour analysis rather than pixel-level localisation. To the best of our knowledge, this is the first study to address automatic bruise segmentation. Our results show that BruNet outperforms CNN-based models, state-of-the-art segmentation models, ChatGPT-4o/5-assisted SAM2 zero-shot baselines, and the medical-oriented MedSAM model, demonstrating strong cross-domain generalisation to bruise segmentation.

Basal Cell Carcinoma (BCC) is the most common type of skin cancer, accounting for nearly 80% of skin cancer di- agnoses. Its optimal clinical management is guided by the distinct histopathologic subtype, with aggressive variants requiring more drastic measures. In current clinical practice, subtyping relies on skin biopsies, a procedure both costly and invasive. In this paper, we conduct a preliminary investigation into using deep learning for BCC subtyping, solely from a single dermatoscopic image of the lesion. Given the limited data at our disposal, we employ pre-trained vision transformers (ViTs), a state-of-the-art family of models highly effective for challenging downstream tasks with limited labeled data. Through repeated stratified k-fold cross-validation, we demonstrate that ViTs can achieve superior performance (AUC 0.784 on a dataset of 1271 dermatoscopic images of various BCC subtypes) over standard CNN-based baselines as well as previously-reported human reader perfor- mance, on the task of differentiating aggressive BCCs from other subtype families. These initial findings highlight the potential of combining deep learning and dermatoscopy to provide a biopsy- free alternative for BCC subtyping, thus aiding in improving treatment planning and patient outcomes.

Smartphone skin photographs are indispensable to teledermatology, yet assessing the diagnostic suitability of submitted cases (gradability) remains a critical bottleneck in mobile care workflows. Dermatologists routinely review multiple photographic views (regional, angled, and close-up) to identify consistent textural detail rather than relying on a single image. We present the Semantic Tri-view Pipeline, an interpretable architecture for automated teledermatology gradability screening that formalizes epidermal micro-relief as a computable biomarker of image quality. Using an expert-annotated subset of the public SCIN dataset, we train a lightweight DeepLabV3+ model to segment micro-relief fidelity. These spatial masks are then aggregated across up to three case views with a logistic regression classifier, leveraging viewpoint redundancy to support robustness under uncontrolled smartphone acquisition. This approach learns context-aware, clinically intelligible heuristics, such as penalizing high-fidelity texture in regional distance views. Evaluated at a predefined 90% sensitivity operating point, the system's apparent errors largely reflect subjective clinical variance on borderline cases where clinicians rely on non-visual metadata. On SCIN, performance improves from an AUC of 0.81 (80.6% PPV) on variance-heavy majority-consensus cases to 0.96 (97.7% PPV) on optically unambiguous unanimous cases. Overall, this work delivers an interpretable, privacy-by-design, edge-ready system that can provide real-time feedback during case submission to filter ungradable photo sets before review.

Skin cancer diagnosis from dermoscopic images remains challenging due to high intra-class variability, inter-class similarity, class imbalance, and the limited interpretability of deep learning models. This paper proposes an uncertainty-aware and explainable deep learning framework for multi-class skin lesion classification. The framework combines a vision transformer model (MaxViT-Tiny) with CNN-based models (ConvNeXt-Tiny and EfficientNetV2-B0) through deep ensemble learning. Monte Carlo (MC) Dropout estimates predictive uncertainty and identifies unreliable predictions, while Grad-CAM++, an explainable AI (XAI) technique, provides visual explanations by highlighting lesion regions that influence model decisions. Evaluated on the HAM10000 dataset, the framework achieves 96% accuracy and 99% ROC-AUC under uncertainty-aware filtering (entropy < 1.0, confidence >= 0.7), with macro-average precision, recall, and F1-score of 94%, 95%, and 95%, respectively, and 96% weighted-average scores across all three metrics. The results demonstrate accurate, interpretable, and uncertainty-aware skin lesion classification for trustworthy computer-aided diagnosis.

Relational inductive biases are essential for capturing structural dependencies among data. This study investigates a dual-level relational framework for image classification, bridging the gap between implicit representation learning and explicit structural modelling. We begin by establishing a baseline using an EfficientNetB3 architecture. To move beyond standard convolutional biases, we adopt a patch-based strategy, employing a convolutional masked autoencoder to learn implicit inter-patch relationships through self-supervised reconstruction. We then extend this approach by incorporating explicit relational modelling, organizing the learned embeddings into various graph topologies, including grid-based, random, and k-nearest neighbour structures. Experimental results on the ISIC-2018 and ISIC-2019 skin lesion diagnosis benchmarks show that combining implicit inter-patch modelling with explicit graph-based message passing yields the best performance. On the ISIC-2018 test set, the baseline model achieves a balanced accuracy of 76.17%, which improves to 77.12% with implicit patch-based relational modelling. The fully integrated grid-structured Graph Attention Network further increases performance to 79.27%. Similarly, on ISIC-2019, the implicit approach reaches 59.84% balanced accuracy, while the combination of implicit and explicit modelling yields 60.67%.

Skin lesion classification plays an important role in supporting the early diagnosis of skin cancer. However, automated analysis remains challenging due to class imbalance, inter-class similarity, and intra-class variability in dermoscopic images. This paper proposes a multimodal classification framework that combines Swin Transformer-based image features with structured clinical metadata to improve diagnostic performance through integrated visual-context learning. Experiments on a publicly available dataset show that the proposed model achieves a test accuracy of 92.55% and a macro F1-score of 91.33%, with strong performance across minority classes. Temperature scaling is applied as a post-hoc calibration method, resulting in a reduction in expected calibration error and improving prediction reliability, while uncertainty estimation is incorporated to further assess the confidence of model predictions. Qualitative explainability analysis further shows that the model focuses on lesion regions during inference. Therefore, the results demonstrate that multimodal fusion, combined with calibration and interpretability analysis, provides an effective and trustworthy approach for automated skin lesion classification.

Human-interpretable computer-aided diagnosis is crucial for clinical decision making. Concept-based models excel by providing transparent reasoning and enabling post-hoc, clinician-in-the-loop interventions. However, their rigid dataset-specific adaptation inherently restricts cross-site generalization. Applying them across diverse modalities, such as dermoscopic and clinical photographs, is challenging due to heterogeneous concept taxonomies varying in availability, granularity, and semantics across cohorts. Consequently, adapting Foundation Vision-Language Models (FVLMs) demands costly label engineering and repeated post-training. Existing intervention mechanisms remain rigidly tied to predefined concepts, lacking adaptability and hindering scalable dermatology CAD deployment. To address these bottlenecks, we propose UniCon, an open-linguistic unified concept learning framework for multimodal interpretable vision-language diagnosis. UniCon resolves these challenges through three contributions: (1) A shared semantic representation space via a unified concept prototype codebook, seamlessly coordinating heterogeneous concept systems across modalities without dataset-specific retraining. (2) Open-linguistic based multi-faceted semantic specifications to overcome sparse textual label limitations, improving boundary sensitivity in uncertain clinical contexts. (3) A robust, cross-site adjustable intervention interface powered by reliability-gated bottleneck aggregation, enabling consistent reasoning and transferable clinician corrections. Extensive experiments demonstrate that beyond securing top-tier diagnostic accuracy, UniCon successfully bridges disparate clinical taxonomies, unlocking unprecedented cross-site intervention capabilities. Code is available at https://github.com/wuchengyu123/UniCon.

Background/Objectives: Dermoscopic skin-lesion classifiers lose accuracy when images arrive from a new clinic or a new device. We asked which data augmentations reduce that loss, and measured the effect under a protocol that keeps policy selection separate from policy evaluation. Methods: A ConvNeXt-Large binary malignant-versus-non-malignant classifier was trained on six dermoscopic sources (25,903 images); HAM10000 and ISIC 2016-2020 were held out of training entirely. Single augmentations, photometric combinations and eleven composite policies were ranked on a development split of 1511 held-out images. The winning policy was then evaluated on a confirmation set of 8073 held-out images that took no part in that ranking and from which we removed every image sharing a lesion identifier with the training data and every image contributed by an institution represented in training. Both policies were retrained with four random seeds each and compared with an exact permutation test. Results: The mix policy raised confirmation-set ROC-AUC from 0.787 to 0.826 (+0.039; per-seed ranges 0.772-0.797 and 0.815-0.840, non-overlapping; exact permutation p=0.029), with the same direction on each contributing source. At matched sensitivity the gain is larger in clinical terms: specificity rose from 0.612 to 0.713 at a sensitivity of 0.80, and from 0.284 to 0.397 at a sensitivity of 0.95. In-domain ROC-AUC was preserved (0.938 to 0.941). On an independent clinical cohort acquired with a different device at a different institution (472 images, 22 malignant), performance was maintained (0.934 versus 0.930). Conclusions: Augmentations that model the physical causes of domain shift improve cross-source transfer at no cost to in-domain accuracy, and the improvement survives a selection-disjoint, contamination-free evaluation.

Acne vulgaris affects most adolescents and many adults. Accurate severity grading guides treatment, monitoring, and clinical trial endpoints, but manual assessment using the Investigator's Global Assessment or Hayashi criteria is limited by inter-rater variability and inconsistent imaging conditions. We developed a four-class acne severity classifier based on the Hayashi criteria using transfer learning with an ImageNet-pretrained EfficientNet-B0 model. The model was fine-tuned on the public ACNE04 dataset of 2,983 labeled images using AdamW optimization, geometric and photometric augmentation, and checkpoint selection based on validation macro-F1. On a held-out stratified 15 percent test set, the classifier achieved 93.5 percent accuracy and 94.4 percent macro-F1, with per-class F1 scores from 0.92 to 0.97. Eighty-three percent of errors occurred between adjacent grades. Quadratic-weighted Cohen's kappa was 0.956, with a 95 percent confidence interval of 0.935 to 0.973. Bootstrap confidence intervals indicated stable performance. Grad-CAM visualizations from the final convolutional block focused on clinically relevant facial regions, including the forehead, cheeks, and chin. The complete pipeline is provided as functionally equivalent open-source implementations in Python using PyTorch and timm, and in MATLAB R2026a. The software includes a clinician-facing inference interface and a fallback backbone option that supports operation without specialized pretrained-weight packages. These results show that lightweight transfer learning can provide accurate, balanced, and interpretable acne severity grading while offering a reproducible cross-platform reference for future prospective and device-stratified clinical validation.

This study developed a hybrid computer vision method to quantify exposed skin from images for dermal exposure assessment. Using 170 indoor-painting images, Mask R-CNN first identified human subjects and removed background interference; a color-based algorithm then segmented exposed skin. The resulting exposed-skin-to-body pixel ratios showed approximately 80% agreement with human estimates. The approach demonstrates a scalable way to extract semi-quantitative exposure information from images, with future extensions to body-part recognition, PPE detection, and video-based exposure analysis.

Wound image classification is often treated as a task-specific supervised learning problem, requiring substantial amounts of manually labelled data and retraining when the label space or deployment setting changes. This study evaluated whether small multimodal language models (SMLMs) can provide a training-free alternative for wound classification through retrieval-based in-context learning (ICL). Experiments used two public wound-image datasets: the Kaggle wound dataset (1469 images, 10 classes) and the Medetec dataset (560 images, 9 classes). Eleven SMLMs from the Qwen 3.5, Ministral 3, and Gemma 4 families were evaluated under zero-shot prompting and few-shot prompting with random support examples, embedding-based k-nearest-neighbour (kNN) retrieval, and kNN retrieval followed by maximal marginal relevance reranking (MMR). Retrieval-only weighted-kNN controls, support-set reduction experiments, and support-context size sweeps were used to assess the effects of retrieval, model scale, and prompt length. Query-conditioned ICL consistently outperformed zero-shot and random few-shot prompting. On the Kaggle dataset, the best result was achieved by Qwen 3.5 27B with kNN+MMR, reaching 0.872 accuracy and 0.871 F1 score. On Medetec, Qwen 3.5 27B with kNN+MMR reached 0.678 accuracy and 0.670 F1. Larger models exceeded matched weighted-kNN controls, indicating use of retrieved examples beyond nearest-neighbour voting. Retrieval-based ICL degraded modestly under support-set reduction, and most gains saturated with 8-10 support images. Retrieval-based ICL allows SMLMs to perform adaptable wound image classification without task-specific retraining. Compact retrieved contexts may support practical and privacy-conscious deployment, although performance remains dependent on model scale, retrieval strategy, and dataset difficulty.

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.

Dermatological practice routinely involves measuring and tracking lesion size, morphology and texture, as critical components of wound or skin cancer screening, monitoring and diagnosis. To accomplish this task, practitioners often image the skin surface with commonly available off-the-shelf camera sensors. This has led to an overwhelming research focus on 2D methods while these objectives naturally benefit from 3D information. In this paper, we demonstrate that dense monocular 3D reconstructions, metric scale measurements and rich surface normal texture estimates are achievable for both dermoscopic and macroscopic cases without the need for additional hardware or multiple captures. We present DermDepth, the first single-view metric scale 3D model for the dermatological domain and D-Synth, the first synthetic dermoscopic dataset with pixel-perfect 3D information. Our experiments show training DermDepth on D-Synth corrects metric scale error from over 16x to under 1.1x for real dermoscopic data, while preserving geometric quality and increasing texture richness. Fine-tuning on a small amount of real clinical samples generalizes our method across three real-world benchmarks spanning the few mm to hundred cm range, diverse skin-tones, chronic wound cases and produces measurements broadly consistent with disease size reported in medical literature. All code, data and models are available at https://github.com/hectorcarrion/dermdepth.

Accurate dermatological diagnosis naturally necessitates equitable performance across diverse populations, yet a systematic lack of expertly annotated images, especially for underrepresented skin tones and rare diseases, impedes progress toward measurably fair methods. We introduce cgDDI (Controllable Generation of Diverse Dermatological Imagery), a hybrid framework that (1) synthesizes realistic healthy skin samples without disturbing other input properties, (2) maps single-sample rare lesions onto novel skin-tones and locations non-parametrically, and (3) allows for efficient parametric generation with as few as 10 training samples. The framework supports both human and automated segmentation masking, enabling scalability to datasets without pre-made lesion masks. We grow a 656-image dataset by more than 400x and validate across two datasets: biopsy-confirmed Diverse Dermatology Images (DDI) and expert-verified Fitzpatrick17k (F17k). On the DDI benchmark, we achieve malignancy classification accuracy of 86.4% under synthetic-only training and 90.9% state-of-the-art performance with real data fine-tuning, alongside leading fairness metrics. Cross-dataset experiments show +13.9% accuracy improvements on unseen F17k data despite minimal disease overlap. We openly release 266k+ synthetic images, code, and generative models to further support fairness research at https://github.com/hectorcarrion/ControllableGenDDI.

Microbial keratitis requires rapid pathogen identification to guide treatment, but culture- and PCR-based diagnostics are slow and resource-intensive. We developed a triple-phase multimodal framework for bacterial-versus-fungal keratitis classification using slit-lamp photographs acquired under blue-light, sclerotic-scatter, and white-light illumination, together with clinical metadata. The model combines cross-modality contrastive learning, modality-specific fine-tuning, and feature-level multimodal ensemble learning for patient-level prediction. We evaluated the framework on a multicenter dataset of 1,645 patients and 17,158 images from India and the United States. The model achieved 85.84% accuracy, 84.46% average F1-score, and 0.885 AUC. Site-specific evaluation showed that pooled results were overly optimistic, whereas resampling- and balance-based re-evaluation provided a more realistic assessment of cross-site generalization. Under all settings, our framework remained the top-performing approach. The code is available at https://github.com/yqwang01/TPMKA and dataset access will be provided subject to University of Michigan data-sharing clearance.

Automated diabetic retinopathy (DR) grading from colour fundus photographs can achieve strong predictive performance, but clinical interpretation requires more than an image-level label. It requires understanding how lesion evidence is distributed around retinal vessels and how this evidence relates to quantitative vascular biomarkers. We present a dual-edge spatial-Jacobian image graph for interpretable DR grading. Each fundus image is represented as a graph node with four aligned evidence streams: AutoMorph vessel information ($X_1$), DR-XAI-style lesion evidence maps ($X_2$), a 128-dimensional lesion-based contrastive image embedding ($X_3$), and AutoMorph morphometric biomarkers ($X_4$). The spatial edge branch ($X_{12}$) encodes vessel-lesion geometry, while the Jacobian branch ($X_{34}$) models embedding-biomarker sensitivity. Lightweight two-token attention fuses both edge families into a final image graph. On 2,910 matched non-augmented APTOS images, the full graph achieves 0.8076 accuracy, 0.8312 quadratic weighted kappa, 0.5915 macro-F1, and 0.9330 adjacent-grade accuracy; referable DR reaches 0.9055 accuracy and 0.9711 AUROC. The framework is positioned as an explainable representation-learning tool for lesion-biomarker hypothesis generation, rather than as a deployment-ready clinical classifier. The code is available at https://github.com/Inamullah-Colab/dual-edge-dr-graph-xai.

The clinical diagnosis of skin diseases is susceptible to interference from inter-class similarity of skin lesions, and over-reliance on clinicians'experience easily leads to subjective bias. Although existing deep learning aided diagnosis methods achieve competitive accuracy, they suffer from the black-box opacity of Vision Transformer (ViT) and poor adaptability to medical few-shot scenarios. Moreover, mainstream explainable algorithms generally face the bottleneck of significant accuracy degradation when improving interpretability. This paper proposes an interpretable ViT (IViT) constrained by Quadratic Programming (QP). The introduced pre-trained transfer learning adapts to few-shot feature extraction. A discrete QP feature selection framework is constructed to screen generic and discriminative features consistent with clinical diagnostic logic. A multi-objective loss function is designed to reduce feature redundancy and optimize activation distribution while preserving classification performance. Experimental results on six standard skin disease datasets show that IViT achieves an accuracy of 93.80%, only 0.21% lower than the baseline, with feature redundancy reduced by 29.5%. Its core activation regions are consistent with clinically concerned lesion areas. The proposed model balances accuracy and interpretability, providing a reliable solution for the clinical deployment of few-shot intelligent skin disease diagnosis.

Automated skin cancer classification from dermoscopic images remains challenging due to heterogeneous lesion structure, strong intra-class variability, and subtle visual differences between benign and malignant cases. Existing CNN/ViT pipelines typically rely on global or patch-level features and often combine patient metadata via late fusion, which limits spatially grounded multimodal reasoning. We present a novel region-based graph learning framework that explicitly models lesions as graphs of spatially coherent superpixel regions represented as frozen CNN features. To capture fine-grained lesion arrangements, we encode inter-regional geometry as edge attributes and introduce a dedicated metadata context node connected to all regions, providing structured integration of demographic/clinical variables within the same relational space. Node representations are updated using our edge-aware graph transformer followed by attention-driven propagation, and a final graph-level embedding for benign-malignant classification. Experiments on four public benchmarks demonstrate that explicit region-level relational modeling and graph-native multimodal fusion yield consistent gains over the state-of-the-art. Consequently, we establish a new graph-centric perspective in which CNN features are modeled as relational nodes and improved through contextual integration, yielding more expressive and robust classifications.

Automated segmentation of skin lesions using deep learning models for dermoscopic images can be very helpful in finding melanomas earlier than they would normally be detected. However, most deep learning methods available do not perform well. The aim of this paper is to present a parameter-efficient fine-tuning method called PEFT-MedSAM for adapting the Medical Segment Anything Model (MedSAM) to automatically segment dermoscopic skin lesions. The PEFT-MedSAM method uses only the lightweight mask decoder for training the model while keeping the pre-trained image encoder and prompt encoder frozen. The experiments performed on the ISIC 2018 benchmark dataset shows that PEFT-MedSAM obtains a dice coefficient of .9411 and an intersection over union value of .8918 when compared to both a fully trained U-Net baseline (.8715 dice coefficient) and zero-shot MedSAM inference (.8997 dice coefficient). The external validation of the model using PH2 dataset shows .9467 dice coefficient with +/- .0310 standard deviation. Supportive evidence for these claims include a p-value less than .0001 for Wilcoxon signed rank tests comparing the two datasets and bootstrap-estimated 95% confidence intervals of [.9364,.9447] that represent the estimated range of possible values for the average dice coefficient obtained by repeating the test. To increase clinical trustworthiness, we used Grad-CAM explainability along with a pointing game based evaluation methodology to evaluate the CNN baseline model on the validation set. The results showed that we had an accuracy rate of 98.27% on the validation set of 519 images and confirmed that the model classified regions containing skin lesions.

This study proposes a domain-specific LLM-based Visual Explanation Evaluation Framework for assessing Grad-CAM explanations in facial skin disease diagnosis models. While previous studies have primarily focused on improving classification performance through data augmentation techniques, relatively few studies have systematically examined whether model explanations are grounded in clinically relevant lesion regions. In this study, geometric augmentation, color-based augmentation, and mixed augmentation strategies were applied to facial skin disease classification models based on EfficientNet-B0, MobileNetV3, and ResNet18. Grad-CAM was employed to generate visual explanations representing the models' decision-making processes. Furthermore, an LLM-as-a-Judge evaluation framework was designed using GPT-5.5, Gemini 3.5 Flash, and Claude Sonnet 4.6 to assess Grad-CAM explanations from the perspectives of lesion localization and explanation trustworthiness. To improve evaluation consistency and clinical grounding, a progressive prompt engineering strategy was introduced, incorporating evaluation rubrics, clinical knowledge, penalty rules, and structured output formats.

Melanoma is the most dangerous form of skin cancer with five-year survival rates exceeding 99% when detected early but falling sharply once the disease spreads. This paper proposes and evaluates a two-stage fine-tuning approach for ResNet50 applied to binary melanoma classification on dermoscopic images. The core challenges addressed are class imbalance and suboptimal transfer learning from single-stage fine-tuning. After stratified train/validation/test splitting, random oversampling was applied exclusively to the training set to achieve a 1:1 class balance. Stage 1 trained only the classification head with the ResNet50 base frozen, while Stage 2 fine-tuned all layers jointly at a low learning rate of 1e-5 to prevent catastrophic forgetting of learned visual features. On an independent test set of 3,826 images, the model achieved an AUC-ROC of 0.9559, accuracy of 88.34%, sensitivity of 87.56%, specificity of 89.13%, and F1-score of 88.29%. An ablation study confirms the two-stage protocol significantly outperforms single-stage fine-tuning, with sensitivity gains of over 4%. Grad-CAM visualizations demonstrate correct lesion localization. A fully deployable Streamlit detection application is provided alongside all training code.

Purpose. To compare deep learning architectures and classification schemes for dermoscopic images of skin neoplasms and assess their generalization on transfer from open international datasets to independent clinical datasets of Russian practice. Methods. Four architectures (ViT-B/16, Swin-S, ConvNeXt-S, EfficientNetV2-S) were compared in three schemes: binary (malignant/benign), single-stage four-class (benign, MEL, SCC, BCC), and a two-stage cascade (binary triage, then three-class differentiation MEL/SCC/BCC). All models used ImageNet-pretrained weights and a single augmentation protocol on aggregated open ISIC Archive data, and were evaluated on an internal held-out sample and two clinical datasets (Melanoscope AI mobile system; Sechenov University). Results. Internally the binary stage attains ROC-AUC 0.952-0.966; on Sechenov University it drops to 0.797-0.893, sensitivity to 0.53-0.67, and ECE rises from 0.02 to 0.27-0.39 with underestimation of malignancy, quantifying a generalization gap in ranking and calibration. Paired tests confirm one inter-architecture result on clinical data: the deficit of ViT-B/16 at the binary stage (p<0.05); at the differentiation stage no architecture has a proven advantage. The cascade raises macro F1 over single-stage four-class classification for most architectures, but significantly only for ViT-B/16, by recovering malignant lesions assigned to the dominant benign class. On ISIC MILK10k, direct 11-class classification yields mean-class sensitivity 0.525. Conclusion. A tunable triage threshold gives sensitivity control not attainable in standard single-stage (argmax) classification and better reproduces clinical differential-diagnosis logic. The persistent generalization gap mandates external clinical validation and recalibration before deployment.

Skin cancer is among the most prevalent malignancies worldwiAdbe satnradcitts early detection is essential for improving patient survival and reducing treatment costs Conventional dermoscopic and visual imaging techniques are primarily limited to the visible spectrum and often fail to capture subtle spectral signatures associated with early stage malignancies This study proposes an innovative framework that integrates a multispectral metasurface for imaging with a hybrid deep learning architecture based on Convolutional Neural Networks and Vision Transformers The designed metasurface enables noninvasive acquisition of rich spectral information highly sensitive to tissue alterations while the hybrid CNN ViT model simultaneously extracts local and global features to robustly classify skin lesions Simulation-based evaluations demonstrate that the proposed method achieves approximately 98 accuracy 95 percentages sensitivity and 99 perentage specificity surpassing conventional RGB-based and single-architecture approaches Qualitative analyses using attention maps reveal that the model focuses on clinically relevant lesion regions improving interpretability Overall the results indicate that combining metasurface based multispectral imaging with hybrid deep learning can introduce a new generation of diagnostic tools in dermatology and pave the way for portable fast and highly accurate clinical systems

Background: Dermatology AI has mainly focused on image-based diagnosis, while chronic disease workflows have received less attention. We surveyed Indian dermatologists to map routine clinical challenges, with a focus on atopic dermatitis (AD), and assess current AI use. Methods: A nationwide cross-sectional survey commissioned by the Society for Eczema Studies included 377 practicing Indian dermatologists. The survey assessed clinical challenges, AD workflow barriers, AI use, adoption barriers, and ethical concerns. Analyses used descriptive statistics, chi-square tests, false discovery rate correction, and multivariable logistic regression. Results: Patient adherence (61.3%) and treatment planning in difficult or refractory cases (57.0%) were reported more often than diagnostic uncertainty (48.0%). In AD care, severity scoring was reported as a challenge by 47.7% and had the lowest satisfaction among measured workflow areas. Current AI use was reported by 49.9%, most often involving general large language models for literature synthesis, documentation, and academic tasks rather than specialized image analysis. Barriers differed by experience: dermatologists with more than 20 years of practice more often cited lack of training, while those with 5 years or less more often cited lack of clinical utility after trying AI tools. AI users were more likely than non-users to report concern about patient self-misdiagnosis and anxiety, which remained significant after adjustment for experience and academic affiliation. Conclusion: Respondents reported using general-purpose AI mainly for cognitive and administrative tasks, while their clinical needs centered on chronic disease management and AD workflow support. Clinician-supervised workflow tools may be more useful than standalone diagnostic applications.

In this study, we evaluate the performance of skin lesion classification using ResNet-based convolutional models, focusing on the impact of demographic bias in training data, particularly variations in patient sex and age. We use linear programming to generate datasets with controlled demographic characteristics, allowing systematic investigation of bias effects. Three learning strategies are evaluated: a single-task model, a reinforcing multi-task model, and an adversarial learning scheme. Our sex-based analysis indicates that sex-specific training datasets optimise model performance. Notably, including male patients in the training data improved performance for the male subgroup, even in female-majority cases. Reinforcing and adversarial learning schemes narrowed or eliminated bias gaps in balanced and female-majority datasets. However, these strategies proved less effective in male-majority settings, where models continued to perform better for males than females. The two learning schemes showed marginal bias reduction compared to the baseline model in predominantly male patient populations. Age-based analysis demonstrates comparable baseline performance across the three model approaches, with performance declining across age categories. Younger groups consistently achieve the highest performance, regardless of training data distribution. Although balanced training yields optimal results for the youngest age category, performance decreases in older categories. We find that sex biases arise mainly from data imbalances, while age biases consistently favour younger groups regardless of distribution. These distinct mechanisms require targeted mitigation strategies. Additionally, cross-dataset validation on two external datasets revealed that domain shifts notably affect performance and patterns of demographic bias.

Models for AI-based skin cancer screening suffer a severe performance drop when shifting from expert dermoscopic (source) images to consumer-grade clinical (target) images, hindering real-world deployment. Existing domain adaptation methods often ignore crucial semantic invariants, such as clinical concepts. While new foundation models like MONET can provide this semantic information as dense, probabilistic scores, this metadata is unavailable at test time, creating a deployment paradox for practical image-only screening tools. We address this gap by proposing CoFiDA-M, a privileged information framework that learns from concepts at training time but deploys as an image-only model. Our method trains a teacher network that uses MONET concept probabilities to guide a FiLM modulator, transforming visual features into a semantically edited" feature space. A lightweight, image-only student is then trained to reproduce this edited representation, not just the teacher's final predictions. This distillation bakes" the clinical reasoning into the student's weights. On a challenging multi-dataset benchmark, our image-only student significantly outperforms state-of-the-art approaches, especially in melanoma recall. Our work provides a practical and generalizable framework for leveraging noisy, probabilistic metadata as privileged information, demonstrating strong cross-dataset robustness and potential for real-world deployment beyond dermatology. Implementation code is available at: https://github.com/mmu-dermatology-research/CoFiDA.git

Introduction. Early detection of malignant skin lesions is critical for prognosis, yet dermatologist shortages in Russian regions limit screening coverage. Mobile dermoscopy clinical decision support systems (CDSS) offer a promising approach, with model interpretability and standardised patient routing remaining key barriers to adoption. Aim. To develop a quantitative interpretability assessment method for cascade deep learning models and a three-zone patient routing algorithm, and to conduct a preliminary single-centre prospective clinical validation of the Melanoscope AI CDSS in Russian outpatient practice. Material and methods. Two-stage cascade classification of dermoscopic images; attention map visualisation (attention rollout for ViT and Swin; Grad-CAM for ConvNeXt and EfficientNetV2); quantitative IoU-based agreement assessment between activation maps and expert annotations; prospective single-centre validation across four "Melanoma Day" sessions (Orel, Russia, June 2025 - April 2026). Results. On 176 patients: agreement with expert assessment 88.6%; no false negatives among 5 malignant lesions (95% CI: 47.8-100.0%); specificity 88.3%. Three melanomas and two basal cell carcinomas were histologically confirmed; six dysplastic naevi placed under follow-up. Mean IoU (n=180): ViT - 0.69; Swin - 0.64; ConvNeXt - 0.53; EfficientNetV2 - 0.51. Routing thresholds: P<0.15 / 0.15-0.50 / >=0.50. Conclusion. No false negatives were observed; specificity was 88.3%, supporting screening use. The integrated cascade classification, attention map visualisation with IoU assessment, and three-zone routing provide reproducible, interpretable clinical decision support adaptable to varying resource levels.

Skin cancer is a common and fast rising malignancy worldwide. Early detection is critical for improving outcomes. Deep learning models trained on dermoscopic and clinical images can support automated and fast triage. However, many studies evaluate only a limited set of architectures. Experimental setups also vary across studies. In this paper, we present a unified evaluation of twelve deep learning models for binary skin cancer detection on the PAD-UFES-20 dataset. The models span four families: convolutional neural networks (CNN), vision transformers (ViT), hybrid convolution transformer backbones, and vision language models (VLM). Performance is assessed using AUC, the maximum F1 score with its precision and recall, and sensitivity at 80% specificity, reflecting screening oriented requirements. Our results show that well tuned CNNs already provide strong baselines, but transformer based families consistently improve discrimination. Hybrid models (MaxViT Tiny, CoAtNet0) and a SigLIP based VLM achieve the best overall trade off between ranking performance and clinically relevant operating points, while CLIP based model offers high precision. The full codebase for all experiments is publicly released. Together, these findings offer practical guidance on which model families are most suitable for real world deployment in skin cancer screening and establish a reproducible reference point for future work on PAD-UFES-20.

This study presents a methodology for constructing a clinically verified dataset of dermatoscopic images for medical informatics research. The relevance of the work is driven by the fact that the performance of automated diagnostic support systems depends not only on the volume of images, but also on the reproducibility of the image acquisition procedure, the completeness of structured metadata, and the reliability of diagnostic labels. International collections were primarily created under conditions that differ substantially from routine Russian outpatient practice and mobile dermatoscopy. The proposed methodology integrates three interconnected components: (1) a standard operating procedure (SOP) for acquiring images via mobile dermatoscopy, (2) an information model comprising 16 structured metadata fields organized into six clinically oriented blocks in ISIC-compatible notation, and (3) a multi-stage expert verification of diagnostic labels (initial clinical annotation, consensus review by three specialists, and histological confirmation of all malignant neoplasms). Using this methodology, a dataset of 1,026 unique dermatoscopic images from 443 patients was collected between June 2025 and May 2026. From 1,044 initial records, 18 duplicates were excluded. The dataset includes nine nosological categories; all 39 malignant lesions (18 melanomas, 15 basal cell carcinomas, and 6 squamous cell carcinomas) were histologically verified. Patient age ranged from 2 to 90 years (median 38), with 279 females (63%) and 164 males (37%). Each image is accompanied by expert-annotated dermatoscopic structures and an explicit verification_stage field indicating the level of diagnostic confirmation. The resulting dataset serves as a pilot clinically verified resource suitable for independent model evaluation, domain shift analysis, interpretability studies, and further expansion.

Trust calibration -- aligning user trust judgment with model capability -- is crucial for safe deployment of explainable AI (XAI), yet is often evaluated via global trust ratings detached from objective performance evidence. We present a preregistered, incentivized between-subject online study (N=418 representative UK sample) on explainable skin-lesion classification that disentangles expectation-setting from experienced performance. Participants completed 15 case evaluations using a fixed XAI panel (malignancy score, reliability score, and saliency map). We systematically manipulated five experimental onboarding conditions varying example-based information and limitation disclosures with five stimulus packages naturally varying observed prediction quality. Calibration was operationalized as the deviation between trust-related judgments (TAIS and case-wise ratings) and objective performance benchmarks for the encountered cases, analysed with hierarchical mixed-effects models. Only limitation disclosure for case-wise measures reliably impacts trust calibration, and short-term experience did not yield progressive calibration. Further, the experienced package of stimuli explained substantially more variance than the experimental manipulation. However, participants were hard-pressed to differentiate between case-wise perceived trust, trustworthiness, and accuracy estimation. We discuss implications for designing limitation communication and for measuring and analysing calibration metrics in XAI evaluations. All study materials and data of this study are publicly available for replication and further academic use.

Dermatological diagnosis requires integrating fine-grained visual perception with expert clinical knowledge. Although Multimodal Large Language Models (MLLMs) facilitate interactive medical image analysis, their application in dermatology is hindered by insufficient domain-specific grounding and hallucinations. To address these issues, we propose DermAgent, a collaborative multi-tool agent that orchestrates seven specialized vision and language modules within a Plan-Execute-Reflect framework. DermAgent delivers stepwise, traceable diagnostic reasoning through three core components. First, it employs complementary visual perception tools for comprehensive morphological description, dermoscopic concept annotation, and disease diagnosis. Second, to overcome the lack of domain prior, a dual-modality retrieval module anchors every prediction in external evidence by cross-referencing 413,210 diagnosed image cases and 3,199 clinical guideline chunks. To further mitigate hallucinations, a deterministic critic module conducts strict post-hoc auditing via confidence, coverage, and conflict gates, automatically detecting inter-source disagreements to trigger targeted self-correction. Extensive experiments on five dermatology benchmarks demonstrate that DermAgent consistently outperforms state-of-the-art MLLMs and medical agent baselines across zero-shot fine-grained disease diagnosis, concept annotation, and clinical captioning tasks, exceeding GPT-4o by 17.6% in skin disease diagnostic accuracy and 3.15% in captioning ROUGE-L. Our code is available at https://github.com/YizeezLiu/DermAgent.

Diabetic Retinopathy (DR) is one of the leading causes of preventable blindness, yet rural regions often lack the specialists and infrastructure needed for early detection. Although cloud-based deep learning systems offer high accuracy, they face significant challenges in these settings due to high latency, limited bandwidth, and high data transmission costs. To address these challenges, we propose a two-tier edge-cloud cascade on the public APTOS 2019 Blindness Detection dataset. Tier 1 runs a lightweight MobileNetV3-small model on a local clinic device to perform a binary triage between Referable DR (Classes 2-4) and Non-referable DR (Classes 0-1). Tier 2 runs a RETFoundDINOv2 model in the cloud for ordinal severity grading, but only on the subset of images flagged as referable by Tier 1. On a stratified APTOS test split of 733 images, Tier 1 reaches 98.99% sensitivity and 84.37% specificity at a validation-tuned high-sensitivity threshold. The default cascade forwards 49.52% of test images to Tier 2, reducing cloud calls by 50.48% relative to using a cloud-based model for all images. In the deployed 4-class output space (Class 0-1 / Class 2 / Class 3 / Class 4), the cascade obtains 80.49% accuracy and 0.8167 quadratic weighted kappa; the cloud-only baseline obtains 80.76% accuracy and 0.8184 quadratic weighted kappa. On APTOS, the cascade cuts cloud use by about half with a modest drop in grading performance. Index Terms: Diabetic Retinopathy, Edge-Cloud Cascade, MobileNetV3-small, RETFound-DINOv2, Retinal Screening, tele-ophthalmology

Automated grading of diabetic retinopathy (DR) faces several critical challenges: subtle inter-grade visual distinctions in fine-grained lesion patterns, distributional discrepancies induced by heterogeneous imaging devices and acquisition conditions, and the inherent inability of purely visual approaches to exploit clinical semantic knowledge. In this paper, we propose CLIP-Guided Semantic Diffusion (CGSD), a DR grading framework that synergistically integrates vision-language pretraining with diffusion probabilistic modeling. We adopt a domain-specific vision-language model tailored for DR grading as the semantic guidance module and adapt it to the target domain via Low-Rank Adaptation (LoRA), effectively bridging the distributional gap between the pretrained model and the target dataset with only a minimal number of trainable parameters. Building on this foundation, we construct a cross-modal semantic conditioning vector by computing the dot product between image features and the text description features of each DR grade, yielding a joint representation that simultaneously encodes visual content and clinical-grade semantics. This vector serves as the conditioning signal for the diffusion denoising network, replacing the structurally complex dual-branch visual prior employed in existing diffusion-based classification methods. Experiments on the APTOS 2019 dataset demonstrate that the proposed approach achieves an accuracy of 87.5% and a macro-averaged F1 score of 0.731, outperforming a variety of representative methods. Ablation studies further validate the independent contribution of each constituent module.

Despite the strong performance of Convolutional Neural Networks (CNNs) in disease classification, their effectiveness often depends on access to large annotated datasets, which is an impractical requirement for emerging or rare conditions such as Monkeypox. To overcome this limitation, we propose a few-shot learning (FSL) framework that employs SimpleShot, a lightweight, non-parametric, inductive classifier, for Monkeypox and pox-like skin disease recognition from limited labeled examples. The proposed pipeline passes the skin lesion images through a frozen, pretrained CNN backbone to obtain feature embeddings, which are then classified via SimpleShot using nearest-centroid comparisons in a normalized embedding space. We systematically benchmark six widely used CNN backbones as feature extractors under consistent experimental settings, enabling fair comparison. Experiments on three publicly available datasets (MSLD v1.0, MSID, and MSLD v2.0) are conducted across 2-way, 4-way, and 6-way tasks with 1-shot, 5-shot, and 10-shot configurations. Among all models, MobileNetV2_100 consistently achieves the highest accuracy. In addition, we present a cross-dataset evaluation for Monkeypox classification, revealing that binary Mpox-vs-Others transfer remains comparatively stable while multi-class performance degrades significantly under domain shift. Together, these results demonstrate the practical utility of combining inductive FSL methods with lightweight CNN backbones and highlight the importance of domain robustness for reliable real-world clinical deployment.

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.

Multimodal large language models (MLLMs) have demonstrated promise on publicly available dermatology benchmarks. However, benchmark performance may not generalize to real-world dermatologic decision-making. To quantify this benchmark-to-bedside gap, we evaluated four open-weight MLLMs (InternVL-Chat v1.5, LLaVA-Med v1.5, SkinGPT4 and MedGemma-4B-Instruct) and one commercial MLLM (GPT-4.1) across three publicly available dermatology datasets and a retrospective multi-site hospital-based dermatology consultation cohort comprising 5,811 cases and 46,405 clinical images. Models were evaluated on two clinically relevant tasks: differential diagnosis generation and severity-based triage. Diagnostic performance was modest on public datasets and declined substantially in the real-world cohort. On public benchmarks, top-3 diagnostic accuracy reached 26.55% for the best open-weight model and 42.25% for GPT-4.1. On real-world consultation cases using images alone, top-3 diagnostic accuracy fell to 1.50%-13.35% among open-weight models and 24.65% for GPT-4.1. Incorporating clinical context improved performance across all models, increasing top-3 diagnostic accuracy up to 28.75% among open-weight models and 38.93% for GPT-4.1. However, model outputs were highly sensitive to incomplete or erroneous consultation context. For severity-based triage, models achieved moderate sensitivity (above 60%), suggesting potential utility for screening but insufficient reliability for clinical deployment. These findings demonstrate that benchmark performance substantially overestimates the real-world clinical capability of current dermatology MLLMs.

Skin lesion classification is essential for early dermatological diagnosis, yet many existing computer-aided systems rely primarily on dermoscopic images and underutilize the multimodal evidence routinely available in clinical practice. To address this gap, we propose \textbf{JI-ADF}, a trimodal deep learning framework that integrates dermoscopic images, clinical photographs, and structured patient metadata for clinically grounded skin lesion classification. The proposed architecture combines joint multimodal representation learning with modality-specific auxiliary supervision and an adaptive decision fusion mechanism that dynamically calibrates modality contributions on a per-sample basis. To enhance cross-modal reasoning while preserving modality-specific evidence, we further introduce a multimodal fusion attention (MMFA) module. We evaluate JI-ADF on the large-scale MILK10k benchmark, which reflects real-world clinical acquisition conditions and severe class imbalance. The proposed method demonstrates strong and well-balanced performance across lesion categories, improving sensitivity and Dice score while maintaining high specificity and good calibration. Extensive analyses, including modality ablation, calibration evaluation, and Grad-CAM visualization, further confirm the robustness and clinically meaningful behavior of the model. These results indicate that JI-ADF provides a reliable and practical foundation for multimodal skin lesion classification in real-world clinical settings.

The quality of diabetic retinopathy (DR) screening relies on the ability to correctly grade severity; however, many deep-learning (DL) classifiers cannot be easily interpreted in the clinical context. This study presents a methodology that combines strong discriminative models with multimodal explanations, converting retinal pixels into clinically interpretable outputs. Using the APTOS 2019 benchmark, we evaluated six representative CNN- and transformer-based backbones under a controlled protocol with stratified five-fold cross-validation. We then compared ensembling strategies (hard voting, weighted soft voting, stacking) and investigated a hybrid class-level fusion variant to exploit grade-specific advantages. For interpretability, we produced Grad-CAM++ visual attribution maps and short textual rationales using vision-language models (VLMs) conditioned on the fundus image and classifier outputs under conservative prompting constraints. Modern CNN backbones (ResNet-50 and ConvNeXt-Tiny) provided the strongest single-model baselines, with cross-validated QWK up to 0.919 and 0.914, respectively. Ensembling improved ordinal agreement, and weighted soft voting was the most consistent across folds (QWK 0.934 +/- 0.017). Hybrid class-level fusion was competitive but did not yield a statistically reliable improvement over standard fusion in paired fold comparisons (Holm-adjusted p >= 1.000). For explanation quality, Grad-CAM++ offered plausible but coarse localization, and VLM rationales were generally grade-consistent. Quantitatively, VLM variants showed a trade-off between clinical completeness and template-level semantic similarity (coverage 0.700 vs. BERTScore 0.072), while image-text alignment was comparable (CLIPScore approximately 0.34).

Concept Bottleneck Models (CBMs) route predictions exclusively through a clinically grounded concept layer, binding interpretability to concept-label consistency. When a dataset contains concept-level inconsistencies, identical concept profiles mapped to conflicting diagnosis labels create an unresolvable bottleneck that imposes a hard ceiling on achievable accuracy. In this paper, we apply rough set theory to the Derm7pt dermoscopy benchmark and characterize the full extent and clinical structure of this inconsistency. Among 305 unique concept profiles formed by the 7 dermoscopic criteria of the 7-point melanoma checklist, 50 (16.4%) are inconsistent, spanning 306 images (30.3% of the dataset). This yields a theoretical accuracy ceiling of 92.1%, independent of backbone architecture or training strategy for CBMs that exclusively operate with hard concepts. In addition, we characterize the conflict-severity distribution, identify the clinical features most responsible for boundary ambiguity, and evaluate two filtering strategies with quantified effects on dataset composition and CBM interpretability. Symmetric removal of all boundary-region images yields Derm7pt+, a fully consistent benchmark subset of 705 images with perfect quality of classification and no hard accuracy ceiling. Building on this filtered dataset, we present a hard CBM evaluated across 19 backbone architectures from the EfficientNet, DenseNet, ResNet, and Wide ResNet families. Under symmetric filtering, explored for completeness, EfficientNet-B5 achieves the best label F1 score (0.85) and label accuracy (0.90) on the held-out test set, with a concept accuracy of 0.70. Under asymmetric filtering, EfficientNet-B7 leads across all four metrics, reaching a label F1 score of 0.82 and concept accuracy of 0.70. These results establish reproducible baselines for concept-consistent CBM evaluation on dermoscopic data.

The integration of medical imaging and clinical text has enabled the emergence of generalist artificial intelligence (AI) systems for healthcare. However, pervasive biases, such as imbalanced disease prevalence, skewed anatomical region distributions, heterogeneous imaging protocols, and demographic disparities, pose significant challenges to the fairness and reliability of vision-language systems in real-world clinical settings. Here we present BiasCareVL, a bias-aware multimodal learning framework that introduces bias control directly into model design, rather than treating it as a post hoc correction. BiasCareVL incorporates adaptive uncertainty modeling with optional human-in-the-loop refinement to regulate the influence of dominant data patterns and to promote equitable reasoning under distributional imbalance. Trained on 3.44 million samples spanning over 15 imaging modalities, the framework supports diverse clinical tasks, including visual question answering, disease classification, segmentation, and report generation within a unified representation space. Across eight public benchmarks covering dermatology, oncology, radiology, and pathology, BiasCareVL consistently outperforms 20 state-of-the-art methods, with pronounced gains in clinically challenging scenarios, including over 10% accuracy improvement in multi-class skin lesion diagnosis and more than 20% Dice improvement in small tumor segmentation. Furthermore, BiasCareVL achieves diagnostic performance exceeding human accuracy with substantially reduced time requirements when evaluated with board-certified radiologists. By open-sourcing BiasCareVL, we aim to promote a transparent, reproducible, and equitable future for AI in healthcare, paving the way for general-purpose, trustworthy, and clinically reliable AI systems.

Accurately quantifying vitiligo extent in routine clinical photographs is crucial for longitudinal monitoring of treatment response. We propose a trustworthy, frequency-aware segmentation framework built on three synergistic pillars: (1) a data-efficient training strategy combining domain-adaptive pre-training on the ISIC 2019 dataset with an ROI-constrained dual-task loss to suppress background noise; (2) an architectural refinement via a ConvNeXt V2-based encoder enhanced with a novel High-Frequency Spectral Gating (HFSG) module and stem-skip connections to capture subtle textures; and (3) a clinical trust mechanism employing K-fold ensemble and Test-Time Augmentation (TTA) to generate pixel-wise uncertainty maps. Extensive validation on an expert-annotated clinical cohort demonstrates superior performance, achieving a Dice score of 85.05% and significantly reducing boundary error (95% Hausdorff Distance improved from 44.79 px to 29.95 px), consistently outperforming strong CNN (ResNet-50 and UNet++) and Transformer (MiT-B5) baselines. Notably, our framework demonstrates high reliability with zero catastrophic failures and provides interpretable entropy maps to identify ambiguous regions for clinician review. Our approach suggests that the proposed framework establishes a robust and reliable standard for automated vitiligo assessment.

Vision--language models (VLMs) have recently shown promise for assisting clinical reasoning in dermatological diagnosis. However, their trustworthiness and clinical utility remain limited by three key challenges: heterogeneous datasets with inconsistent diagnostic labels and concept annotations, the lack of grounded diagnostic rationales for reliable reasoning supervision, and limited scalability when transferring knowledge from small, densely annotated datasets to large collections with sparse labels. To address these challenges, we propose Skin-R1, a dermatology-oriented VLM that integrates textbook-grounded clinical reasoning supervision with reinforcement learning (RL) to improve the accuracy and robustness of diagnostic prediction. First, we construct a textbook-based reasoning generator that synthesizes hierarchy-aware and differential-diagnosis (DDx) diagnostic trajectories derived from authoritative dermatology knowledge. Second, these trajectories are used for supervised fine-tuning (SFT), establishing a clinically grounded reasoning foundation for the model. Finally, we introduce an RL training framework that incorporates the hierarchical structure of dermatological diseases into the reward design, enabling the model to generalize grounded diagnostic reasoning to large-scale datasets with sparse annotations. Extensive experiments across multiple dermatology benchmarks demonstrate that Skin-R1 consistently improves diagnostic accuracy and robustness compared to state-of-the-art Med-VLM baselines. Ablation studies further highlight the critical role of grounded reasoning supervision introduced during the SFT stage.

Melanoma is a highly aggressive skin cancer, making early and accurate diagnosis critical. While deep learning excels in skin lesion classification, standard ``black-box" models struggle to explain diagnostic uncertainty, limiting clinical trust. This work introduces a hybrid framework combining a class-aware adversarial Variational Autoencoder and an XGBoost classifier, transcending simple binary classification by leveraging a generative latent space for interpretable decision support. Guided by adversarial training, the model learns the visual characteristics of skin lesions and projects them into a continuous latent space, ensuring that similar images are grouped closely together. Trained on this latent space, the XGBoost classifier achieves a robust AUC of 0.868, competing closely with state-of-the-art models. For borderline cases, the framework enables clinicians to leverage the latent topology through Content-Based Image Retrieval. This provides a dual benefit: it allows the clinician to visually compare an ambiguous lesion against biopsy-confirmed precedents and acts as an early warning sign since a borderline classification can indicate that a lesion shares features of both nevi and melanomas, potentially requiring close monitoring. Our approach translates algorithmic hesitation into transparent, evidence-based visual support, bridging the gap between predictive performance and clinical trust.

The rising prevalence of chronic wounds, especially in aging populations, presents a significant healthcare challenge due to prolonged hospitalizations, elevated costs, and reduced patient quality of life. Traditional wound care is resource-intensive, requiring frequent in-person visits that strain both patients and healthcare professionals (HCPs). Thus, we present WoundAIssist, a patient-centered, AI-driven mobile application supporting telemedical wound care. WoundAIssist enables patients to document wounds at home via photographs and questionnaires, while physicians remain engaged in the care process through remote monitoring and video consultations. A distinguishing feature is an integrated lightweight deep learning model for on-device wound segmentation, guiding users during image capture. Combined with patient-reported data and server-side AI analysis, this enables continuous monitoring of wound healing progression. Developed through an iterative, user-centered process involving patients and domain experts, WoundAIssist prioritizes an user-friendly design, particularly for elderly patients. A conclusive usability study with patients and dermatologists reported excellent usability, good app quality, and favorable perceptions of the AI-driven wound recognition. Our main contribution is two-fold: (I) the development and (II) evaluation of WoundAIssist, an easy-to-use yet comprehensive telehealth solution designed to bridge the gap between patients and HCPs. Additionally, we synthesize design insights for remote patient monitoring apps, derived from over three years of interdisciplinary research, that may inform the development of similar digital health tools across clinical domains.

Hierarchical classification aims to sort the object into a hierarchical structure of categories. For example, a bird can be categorized according to a three-level hierarchy of order, family, and species. Existing methods commonly address hierarchical classification by decoupling it into a series of multi-class classification tasks. However, such a multi-task learning strategy fails to fully exploit the correlation among various categories across different levels of the hierarchy. In this paper, we propose Label Hierarchy Transition (LHT), a unified probabilistic framework based on deep learning, to address the challenges of hierarchical classification. The LHT framework consists of a transition network and a confusion loss. The transition network focuses on explicitly learning the label hierarchy transition matrices, which has the potential to effectively encode the underlying correlations embedded within class hierarchies. The confusion loss encourages the classification network to learn correlations across different label hierarchies during training. The proposed framework can be readily adapted to any existing deep network with only minor modifications. We experiment with a series of public benchmark datasets for hierarchical classification problems, and the results demonstrate the superiority of our approach beyond current state-of-the-art methods. Furthermore, we extend our proposed LHT framework to the skin lesion diagnosis task and validate its great potential in computer-aided diagnosis. The code of our method is available at \href{https://github.com/renzhenwang/label-hierarchy-transition}{https://github.com/renzhenwang/label-hierarchy-transition}.

This paper outlines the specifications and design approach used to construct a full body imaging scanner capable of capturing skin lesions at a dermatoscopic level using cameras mounted on the end-effectors of four UR10 manipulators. The system possesses a view-planning algorithm capable of appropriately selecting the best camera position to acquire images of moles, a high-level controller to allow the manipulators to work simultaneously and a collision-detector that halts the manipulators when they make contact with an object or a person. We evaluate the system through real-patient full-body scans, comparing acquired images against contact dermoscopy and an existing total-body photography system (Vectra) across clinically relevant lesion features, and quantify true optical resolving power using a USAF 1951 resolution target, yielding a smallest resolvable feature size of 22.1 microns for our scanner compared to 8.8 microns for contact dermoscopy. Results show the scanner consistently outperforms Vectra across most clinically relevant features and achieves comparable performance to contact dermoscopy for the majority of features assessed. By acquiring dermatoscopic-quality images automatically and without contact, and without requiring a separate manual dermoscopic examination, the scanner closes part of the gap between total-body photography and handheld dermoscopy, suggesting potential for future integration into screening workflows.