Daily Papers

Multi-annotator medical image segmentation is an important research problem, but requires annotated datasets that are expensive to collect. Dermoscopic skin lesion imaging allows human experts and AI systems to observe morphological structures otherwise not discernable from regular clinical photographs. However, currently there are no large-scale publicly available multi-annotator skin lesion segmentation (SLS) datasets with annotator-labels for dermoscopic skin lesion imaging. We introduce ISIC MultiAnnot++, a large public multi-annotator skin lesion segmentation dataset for images from the ISIC Archive. The final dataset contains 17,684 segmentation masks spanning 14,967 dermoscopic images, where 2,394 dermoscopic images have 2-5 segmentations per image, making it the largest publicly available SLS dataset. Further, metadata about the segmentation, including the annotators' skill level and segmentation tool, is included, enabling research on topics such as annotator-specific preference modeling for segmentation and annotator metadata analysis. We provide an analysis on the characteristics of this dataset, curated data partitions, and consensus segmentation masks.

This article summarizes the BCN20000 dataset, composed of 19424 dermoscopic images of skin lesions captured from 2010 to 2016 in the facilities of the Hospital Cl\'inic in Barcelona. With this dataset, we aim to study the problem of unconstrained classification of dermoscopic images of skin cancer, including lesions found in hard-to-diagnose locations (nails and mucosa), large lesions which do not fit in the aperture of the dermoscopy device, and hypo-pigmented lesions. The BCN20000 will be provided to the participants of the ISIC Challenge 2019, where they will be asked to train algorithms to classify dermoscopic images of skin cancer automatically.

This article describes the design, implementation, and results of the latest installment of the dermoscopic image analysis benchmark challenge. The goal is to support research and development of algorithms for automated diagnosis of melanoma, the most lethal skin cancer. The challenge was divided into 3 tasks: lesion segmentation, feature detection, and disease classification. Participation involved 593 registrations, 81 pre-submissions, 46 finalized submissions (including a 4-page manuscript), and approximately 50 attendees, making this the largest standardized and comparative study in this field to date. While the official challenge duration and ranking of participants has concluded, the dataset snapshots remain available for further research and development.

Medical image segmentation exhibits intra- and inter-annotator variability due to ambiguous object boundaries, annotator preferences, expertise, and tools, among other factors. Lesions with ambiguous boundaries, e.g., spiculated or infiltrative nodules, or irregular borders per the ABCD rule, are particularly prone to disagreement and are often associated with malignancy. In this work, we curate IMA++, the largest multi-annotator skin lesion segmentation dataset, on which we conduct an in-depth study of variability due to annotator, malignancy, tool, and skill factors. We find a statistically significant (p<0.001) association between inter-annotator agreement (IAA), measured using Dice, and the malignancy of skin lesions. We further show that IAA can be accurately predicted directly from dermoscopic images, achieving a mean absolute error of 0.108. Finally, we leverage this association by utilizing IAA as a "soft" clinical feature within a multi-task learning objective, yielding a 4.2% improvement in balanced accuracy averaged across multiple model architectures and across IMA++ and four public dermoscopic datasets. The code is available at https://github.com/sfu-mial/skin-IAV.

Clinical AI development has traditionally followed a collaborative paradigm that depends on close interaction between clinicians and specialized AI teams. This paradigm imposes a practical challenge: clinicians must repeatedly communicate and refine their requirements with AI developers before those requirements can be translated into executable model development. This iterative process is time-consuming, and even after repeated discussion, misalignment may still exist because the two sides do not fully share each other's expertise. However, autonomous coding agents may change this paradigm, raising the possibility that clinicians could develop clinical AI models independently through natural-language interaction alone. In this study, we present such an autonomous prototype for clinician-driven clinical AI development. We evaluated the system on five clinical tasks spanning dermoscopic lesion classification, melanoma-versus-nevus triage, wrist-fracture detection (including a weakly supervised variant with only 5% bounding-box annotations), and debiased pneumothorax classification on chest radiographs. Across these settings, the system consistently developed models from clinician requests and achieved promising performance. Notably, in a debiased pneumothorax classification task on chest radiographs, where chest drains can act as a major confounder, the system successfully mitigated shortcut learning and nearly halved the model's reliance on chest drains. These findings provide proof of concept that autonomous coding agents may help shift clinical AI development toward a more clinician-driven paradigm, reducing the communication overhead and dependence on specialized AI developers. Although further validation and robustness assessment are needed, this study suggests a promising path toward making clinical AI development more accessible.

Diagnosing and treating skin diseases require advanced visual skills across domains and the ability to synthesize information from multiple imaging modalities. While current deep learning models excel at specific tasks like skin cancer diagnosis from dermoscopic images, they struggle to meet the complex, multimodal requirements of clinical practice. Here, we introduce PanDerm, a multimodal dermatology foundation model pretrained through self-supervised learning on over 2 million real-world skin disease images from 11 clinical institutions across 4 imaging modalities. We evaluated PanDerm on 28 diverse benchmarks, including skin cancer screening, risk stratification, differential diagnosis of common and rare skin conditions, lesion segmentation, longitudinal monitoring, and metastasis prediction and prognosis. PanDerm achieved state-of-the-art performance across all evaluated tasks, often outperforming existing models when using only 10% of labeled data. We conducted three reader studies to assess PanDerm's potential clinical utility. PanDerm outperformed clinicians by 10.2% in early-stage melanoma detection through longitudinal analysis, improved clinicians' skin cancer diagnostic accuracy by 11% on dermoscopy images, and enhanced non-dermatologist healthcare providers' differential diagnosis by 16.5% across 128 skin conditions on clinical photographs. These results demonstrate PanDerm's potential to improve patient care across diverse clinical scenarios and serve as a model for developing multimodal foundation models in other medical specialties, potentially accelerating the integration of AI support in healthcare. The code can be found at https://github.com/SiyuanYan1/PanDerm.

In this article, we describe the design and implementation of a publicly accessible dermatology image analysis benchmark challenge. The goal of the challenge is to sup- port research and development of algorithms for automated diagnosis of melanoma, a lethal form of skin cancer, from dermoscopic images. The challenge was divided into sub-challenges for each task involved in image analysis, including lesion segmentation, dermoscopic feature detection within a lesion, and classification of melanoma. Training data included 900 images. A separate test dataset of 379 images was provided to measure resultant performance of systems developed with the training data. Ground truth for both training and test sets was generated by a panel of dermoscopic experts. In total, there were 79 submissions from a group of 38 participants, making this the largest standardized and comparative study for melanoma diagnosis in dermoscopic images to date. While the official challenge duration and ranking of participants has concluded, the datasets remain available for further research and development.

Medical vision-language models (VLMs) have shown promise as clinical assistants across various medical fields. However, specialized dermatology VLM capable of delivering professional and detailed diagnostic analysis remains underdeveloped, primarily due to less specialized text descriptions in current dermatology multimodal datasets. To address this issue, we propose MM-Skin, the first large-scale multimodal dermatology dataset that encompasses 3 imaging modalities, including clinical, dermoscopic, and pathological and nearly 10k high-quality image-text pairs collected from professional textbooks. In addition, we generate over 27k diverse, instruction-following vision question answering (VQA) samples (9 times the size of current largest dermatology VQA dataset). Leveraging public datasets and MM-Skin, we developed SkinVL, a dermatology-specific VLM designed for precise and nuanced skin disease interpretation. Comprehensive benchmark evaluations of SkinVL on VQA, supervised fine-tuning (SFT) and zero-shot classification tasks across 8 datasets, reveal its exceptional performance for skin diseases in comparison to both general and medical VLM models. The introduction of MM-Skin and SkinVL offers a meaningful contribution to advancing the development of clinical dermatology VLM assistants. MM-Skin is available at https://github.com/ZwQ803/MM-Skin

Recently, there has been great interest in developing Artificial Intelligence (AI) enabled computer-aided diagnostics solutions for the diagnosis of skin cancer. With the increasing incidence of skin cancers, low awareness among a growing population, and a lack of adequate clinical expertise and services, there is an immediate need for AI systems to assist clinicians in this domain. A large number of skin lesion datasets are available publicly, and researchers have developed AI-based image classification solutions, particularly deep learning algorithms, to distinguish malignant skin lesions from benign lesions in different image modalities such as dermoscopic, clinical, and histopathology images. Despite the various claims of AI systems achieving higher accuracy than dermatologists in the classification of different skin lesions, these AI systems are still in the very early stages of clinical application in terms of being ready to aid clinicians in the diagnosis of skin cancers. In this review, we discuss advancements in the digital image-based AI solutions for the diagnosis of skin cancer, along with some challenges and future opportunities to improve these AI systems to support dermatologists and enhance their ability to diagnose skin cancer.

This work summarizes the results of the largest skin image analysis challenge in the world, hosted by the International Skin Imaging Collaboration (ISIC), a global partnership that has organized the world's largest public repository of dermoscopic images of skin. The challenge was hosted in 2018 at the Medical Image Computing and Computer Assisted Intervention (MICCAI) conference in Granada, Spain. The dataset included over 12,500 images across 3 tasks. 900 users registered for data download, 115 submitted to the lesion segmentation task, 25 submitted to the lesion attribute detection task, and 159 submitted to the disease classification task. Novel evaluation protocols were established, including a new test for segmentation algorithm performance, and a test for algorithm ability to generalize. Results show that top segmentation algorithms still fail on over 10% of images on average, and algorithms with equal performance on test data can have different abilities to generalize. This is an important consideration for agencies regulating the growing set of machine learning tools in the healthcare domain, and sets a new standard for future public challenges in healthcare.

This study explores the potential of graph neural networks (GNNs) to enhance semantic segmentation across diverse image modalities. We evaluate the effectiveness of a novel GNN-based U-Net architecture on three distinct datasets: PascalVOC, a standard benchmark for natural image segmentation, WoodScape, a challenging dataset of fisheye images commonly used in autonomous driving, introducing significant geometric distortions; and ISIC2016, a dataset of dermoscopic images for skin lesion segmentation. We compare our proposed UNet-GNN model against established convolutional neural networks (CNNs) based segmentation models, including U-Net and U-Net++, as well as the transformer-based SwinUNet. Unlike these methods, which primarily rely on local convolutional operations or global self-attention, GNNs explicitly model relationships between image regions by constructing and operating on a graph representation of the image features. This approach allows the model to capture long-range dependencies and complex spatial relationships, which we hypothesize will be particularly beneficial for handling geometric distortions present in fisheye imagery and capturing intricate boundaries in medical images. Our analysis demonstrates the versatility of GNNs in addressing diverse segmentation challenges and highlights their potential to improve segmentation accuracy in various applications, including autonomous driving and medical image analysis.