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Over the past few years, different computer-aided diagnosis (CAD) systems have been proposed to tackle skin lesion analysis. Most of these systems work only for dermoscopy images since there is a strong lack of public clinical images archive available to design them. To fill this gap, we release a skin lesion benchmark composed of clinical images collected from smartphone devices and a set of patient clinical data containing up to 22 features. The dataset consists of 1,373 patients, 1,641 skin lesions, and 2,298 images for six different diagnostics: three skin diseases and three skin cancers. In total, 58.4% of the skin lesions are biopsy-proven, including 100% of the skin cancers. By releasing this benchmark, we aim to aid future research and the development of new tools to assist clinicians to detect skin cancer.
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Prior skin image datasets have not addressed patient-level information obtained from multiple skin lesions from the same patient. Though artificial intelligence classification algorithms have achieved expert-level performance in controlled studies examining single images, in practice dermatologists base their judgment holistically from multiple lesions on the same patient. The 2020 SIIM-ISIC Melanoma Classification challenge dataset described herein was constructed to address this discrepancy between prior challenges and clinical practice, providing for each image in the dataset an identifier allowing lesions from the same patient to be mapped to one another. This patient-level contextual information is frequently used by clinicians to diagnose melanoma and is especially useful in ruling out false positives in patients with many atypical nevi. The dataset represents 2,056 patients from three continents with an average of 16 lesions per patient, consisting of 33,126 dermoscopic images and 584 histopathologically confirmed melanomas compared with benign melanoma mimickers.
Convolutional neural network (CNN) methods have been proposed to quantify lesions in medical imaging. Commonly more than one imaging examination is available for a patient, but the serial information in these images often remains unused. CNN-based methods have the potential to extract valuable information from previously acquired imaging to better quantify current imaging of the same patient. A pre-trained CNN can be updated with a patients previously acquired imaging: patient-specific fine-tuning. In this work, we studied the improvement in performance of lesion quantification methods on MR images after fine-tuning compared to a base CNN. We applied the method to two different approaches: the detection of liver metastases and the segmentation of brain white matter hyperintensities (WMH). The patient-specific fine-tuned CNN has a better performance than the base CNN. For the liver metastases, the median true positive rate increases from 0.67 to 0.85. For the WMH segmentation, the mean Dice similarity coefficient increases from 0.82 to 0.87. In this study we showed that patient-specific fine-tuning has potential to improve the lesion quantification performance of general CNNs by exploiting the patients previously acquired imaging.
All datasets contain some biases, often unintentional, due to how they were acquired and annotated. These biases distort machine-learning models performance, creating spurious correlations that the models can unfairly exploit, or, contrarily destroying clear correlations that the models could learn. With the popularity of deep learning models, automated skin lesion analysis is starting to play an essential role in the early detection of Melanoma. The ISIC Archive is one of the most used skin lesion sources to benchmark deep learning-based tools. Bissoto et al. experimented with different bounding-box based masks and showed that deep learning models could classify skin lesion images without clinically meaningful information in the input data. Their findings seem confounding since the ablated regions (random rectangular boxes) are not significant. The shape of the lesion is a crucial factor in the clinical characterization of a skin lesion. In that context, we performed a set of experiments that generate shape-preserving masks instead of rectangular bounding-box based masks. A deep learning model trained on these shape-preserving masked images does not outperform models trained on images without clinically meaningful information. That strongly suggests spurious correlations guiding the models. We propose use of general adversarial network (GAN) to mitigate the underlying bias.
We consider machine-learning-based malignancy prediction and lesion identification from clinical dermatological images, which can be indistinctly acquired via smartphone or dermoscopy capture. Additionally, we do not assume that images contain single lesions, thus the framework supports both focal or wide-field images. Specifically, we propose a two-stage approach in which we first identify all lesions present in the image regardless of sub-type or likelihood of malignancy, then it estimates their likelihood of malignancy, and through aggregation, it also generates an image-level likelihood of malignancy that can be used for high-level screening processes. Further, we consider augmenting the proposed approach with clinical covariates (from electronic health records) and publicly available data (the ISIC dataset). Comprehensive experiments validated on an independent test dataset demonstrate that i) the proposed approach outperforms alternative model architectures; ii) the model based on images outperforms a pure clinical model by a large margin, and the combination of images and clinical data does not significantly improves over the image-only model; and iii) the proposed framework offers comparable performance in terms of malignancy classification relative to three board certified dermatologists with different levels of experience.
We examine progress in the use of AI for detecting skin lesions, with particular emphasis on the erythema migrans rash of acute Lyme disease, and other lesions, such as those from conditions like herpes zoster (shingles), tinea corporis, erythema multiforme, cellulitis, insect bites, or tick bites. We discuss important challenges for these applications, in particular the problems of AI bias regarding the lack of skin images in dark skinned individuals, being able to accurately detect, delineate, and segment lesions or regions of interest compared to normal skin in images, and low shot learning (addressing classification with a paucity of training images). Solving these problems ranges from being highly desirable requirements -- e.g. for delineation, which may be useful to disambiguate between similar types of lesions, and perform improved diagnostics -- or required, as is the case for AI de-biasing, to allow for the deployment of fair AI techniques in the clinic for skin lesion analysis. For the problem of low shot learning in particular, we report skin analysis algorithms that gracefully degrade and still perform well at low shots, when compared to baseline algorithms: when using a little as 10 training exemplars per class, the baseline DL algorithm performance significantly degrades, with accuracy of 56.41%, close to chance, whereas the best performing low shot algorithm yields an accuracy of 85.26%.
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