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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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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.
For several skin conditions such as vitiligo, accurate segmentation of lesions from skin images is the primary measure of disease progression and severity. Existing methods for vitiligo lesion segmentation require manual intervention. Unfortunately, manual segmentation is time and labor-intensive, as well as irreproducible between physicians. We introduce a convolutional neural network (CNN) that quickly and robustly performs vitiligo skin lesion segmentation. Our CNN has a U-Net architecture with a modified contracting path. We use the CNN to generate an initial segmentation of the lesion, then refine it by running the watershed algorithm on high-confidence pixels. We train the network on 247 images with a variety of lesion sizes, complexity, and anatomical sites. The network with our modifications noticeably outperforms the state-of-the-art U-Net, with a Jaccard Index (JI) score of 73.6% (compared to 36.7%). Moreover, our method requires only a few seconds for segmentation, in contrast with the previously proposed semi-autonomous watershed approach, which requires 2-29 minutes per image.
Medical image segmentation annotations suffer from inter- and intra-observer variations even among experts due to intrinsic differences in human annotators and ambiguous boundaries. Leveraging a collection of annotators opinions for an image is an interesting way of estimating a gold standard. Although training deep models in a supervised setting with a single annotation per image has been extensively studied, generalizing their training to work with datasets containing multiple annotations per image remains a fairly unexplored problem. In this paper, we propose an approach to handle annotators disagreements when training a deep model. To this end, we propose an ensemble of Bayesian fully convolutional networks (FCNs) for the segmentation task by considering two major factors in the aggregation of multiple ground truth annotations: (1) handling contradictory annotations in the training data originating from inter-annotator disagreements and (2) improving confidence calibration through the fusion of base models predictions. We demonstrate the superior performance of our approach on the ISIC Archive and explore the generalization performance of our proposed method by cross-dataset evaluation on the PH2 and DermoFit datasets.
The segmentation of skin lesions is a crucial task in clinical decision support systems for the computer aided diagnosis of skin lesions. Although deep learning-based approaches have improved segmentation performance, these models are often susceptible to class imbalance in the data, particularly, the fraction of the image occupied by the background healthy skin. Despite variations of the popular Dice loss function being proposed to tackle the class imbalance problem, the Dice loss formulation does not penalize misclassifications of the background pixels. We propose a novel metric-based loss function using the Matthews correlation coefficient, a metric that has been shown to be efficient in scenarios with skewed class distributions, and use it to optimize deep segmentation models. Evaluations on three skin lesion image datasets: the ISBI ISIC 2017 Skin Lesion Segmentation Challenge dataset, the DermoFit Image Library, and the PH2 dataset, show that models trained using the proposed loss function outperform those trained using Dice loss by 11.25%, 4.87%, and 0.76% respectively in the mean Jaccard index. The code is available at https://github.com/kakumarabhishek/MCC-Loss.
Skin lesion segmentation is a crucial step in the computer-aided diagnosis of dermoscopic images. In the last few years, deep learning based semantic segmentation methods have significantly advanced the skin lesion segmentation results. However, the current performance is still unsatisfactory due to some challenging factors such as large variety of lesion scale and ambiguous difference between lesion region and background. In this paper, we propose a simple yet effective framework, named Dual Objective Networks (DONet), to improve the skin lesion segmentation. Our DONet adopts two symmetric decoders to produce different predictions for approaching different objectives. Concretely, the two objectives are actually defined by different loss functions. In this way, the two decoders are encouraged to produce differentiated probability maps to match different optimization targets, resulting in complementary predictions accordingly. The complementary information learned by these two objectives are further aggregated together to make the final prediction, by which the uncertainty existing in segmentation maps can be significantly alleviated. Besides, to address the challenge of large variety of lesion scales and shapes in dermoscopic images, we additionally propose a recurrent context encoding module (RCEM) to model the complex correlation among skin lesions, where the features with different scale contexts are efficiently integrated to form a more robust representation. Extensive experiments on two popular benchmarks well demonstrate the effectiveness of the proposed DONet. In particular, our DONet achieves 0.881 and 0.931 dice score on ISIC 2018 and $text{PH}^2$, respectively. Code will be made public available.
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