Roberto A. Novoa

Roxana Daneshjou, Mert Yuksekgonul, Zhuo Ran Cai et al. · stanford

For the deployment of artificial intelligence (AI) in high-risk settings, such as healthcare, methods that provide interpretability/explainability or allow fine-grained error analysis are critical. Many recent methods for interpretability/explainability and fine-grained error analysis use concepts, which are meta-labels that are semantically meaningful to humans. However, there are only a few datasets that include concept-level meta-labels and most of these meta-labels are relevant for natural images that do not require domain expertise. Densely annotated datasets in medicine focused on meta-labels that are relevant to a single disease such as melanoma. In dermatology, skin disease is described using an established clinical lexicon that allows clinicians to describe physical exam findings to one another. To provide a medical dataset densely annotated by domain experts with annotations useful across multiple disease processes, we developed SkinCon: a skin disease dataset densely annotated by dermatologists. SkinCon includes 3230 images from the Fitzpatrick 17k dataset densely annotated with 48 clinical concepts, 22 of which have at least 50 images representing the concept. The concepts used were chosen by two dermatologists considering the clinical descriptor terms used to describe skin lesions. Examples include "plaque", "scale", and "erosion". The same concepts were also used to label 656 skin disease images from the Diverse Dermatology Images dataset, providing an additional external dataset with diverse skin tone representations. We review the potential applications for the SkinCon dataset, such as probing models, concept-based explanations, and concept bottlenecks. Furthermore, we use SkinCon to demonstrate two of these use cases: debugging mistakes of an existing dermatology AI model with concepts and developing interpretable models with post-hoc concept bottleneck models.

Wen-wai Yim, Yujuan Fu, Asma Ben Abacha et al.

Recent advances in dermatological image analysis have been driven by large-scale annotated datasets; however, most existing benchmarks focus on dermatoscopic images and lack patient-authored queries and clinical context, limiting their applicability to patient-centered care. To address this gap, we introduce DermaVQA-DAS, an extension of the DermaVQA dataset that supports two complementary tasks: closed-ended question answering (QA) and dermatological lesion segmentation. Central to this work is the Dermatology Assessment Schema (DAS), a novel expert-developed framework that systematically captures clinically meaningful dermatological features in a structured and standardized form. DAS comprises 36 high-level and 27 fine-grained assessment questions, with multiple-choice options in English and Chinese. Leveraging DAS, we provide expert-annotated datasets for both closed QA and segmentation and benchmark state-of-the-art multimodal models. For segmentation, we evaluate multiple prompting strategies and show that prompt design impacts performance: the default prompt achieves the best results under Mean-of-Max and Mean-of-Mean evaluation aggregation schemes, while an augmented prompt incorporating both patient query title and content yields the highest performance under majority-vote-based microscore evaluation, achieving a Jaccard index of 0.395 and a Dice score of 0.566 with BiomedParse. For closed-ended QA, overall performance is strong across models, with average accuracies ranging from 0.729 to 0.798; o3 achieves the best overall accuracy (0.798), closely followed by GPT-4.1 (0.796), while Gemini-1.5-Pro shows competitive performance within the Gemini family (0.783). We publicly release DermaVQA-DAS, the DAS schema, and evaluation protocols to support and accelerate future research in patient-centered dermatological vision-language modeling (https://osf.io/72rp3).

Kailas Vodrahalli, Justin Ko, Albert S. Chiou et al.

Telemedicine utilization was accelerated during the COVID-19 pandemic, and skin conditions were a common use case. However, the quality of photographs sent by patients remains a major limitation. To address this issue, we developed TrueImage 2.0, an artificial intelligence (AI) model for assessing patient photo quality for telemedicine and providing real-time feedback to patients for photo quality improvement. TrueImage 2.0 was trained on 1700 telemedicine images annotated by clinicians for photo quality. On a retrospective dataset of 357 telemedicine images, TrueImage 2.0 effectively identified poor quality images (Receiver operator curve area under the curve (ROC-AUC) =0.78) and the reason for poor quality (Blurry ROC-AUC=0.84, Lighting issues ROC-AUC=0.70). The performance is consistent across age, gender, and skin tone. Next, we assessed whether patient-TrueImage 2.0 interaction led to an improvement in submitted photo quality through a prospective clinical pilot study with 98 patients. TrueImage 2.0 reduced the number of patients with a poor-quality image by 68.0%.

Roxana Daneshjou, Kailas Vodrahalli, Weixin Liang et al.

More than 3 billion people lack access to care for skin disease. AI diagnostic tools may aid in early skin cancer detection; however most models have not been assessed on images of diverse skin tones or uncommon diseases. To address this, we curated the Diverse Dermatology Images (DDI) dataset - the first publicly available, pathologically confirmed images featuring diverse skin tones. We show that state-of-the-art dermatology AI models perform substantially worse on DDI, with ROC-AUC dropping 29-40 percent compared to the models' original results. We find that dark skin tones and uncommon diseases, which are well represented in the DDI dataset, lead to performance drop-offs. Additionally, we show that state-of-the-art robust training methods cannot correct for these biases without diverse training data. Our findings identify important weaknesses and biases in dermatology AI that need to be addressed to ensure reliable application to diverse patients and across all disease.

Kailas Vodrahalli, Roxana Daneshjou, Roberto A Novoa et al.

Telehealth is an increasingly critical component of the health care ecosystem, especially due to the COVID-19 pandemic. Rapid adoption of telehealth has exposed limitations in the existing infrastructure. In this paper, we study and highlight photo quality as a major challenge in the telehealth workflow. We focus on teledermatology, where photo quality is particularly important; the framework proposed here can be generalized to other health domains. For telemedicine, dermatologists request that patients submit images of their lesions for assessment. However, these images are often of insufficient quality to make a clinical diagnosis since patients do not have experience taking clinical photos. A clinician has to manually triage poor quality images and request new images to be submitted, leading to wasted time for both the clinician and the patient. We propose an automated image assessment machine learning pipeline, TrueImage, to detect poor quality dermatology photos and to guide patients in taking better photos. Our experiments indicate that TrueImage can reject 50% of the sub-par quality images, while retaining 80% of good quality images patients send in, despite heterogeneity and limitations in the training data. These promising results suggest that our solution is feasible and can improve the quality of teledermatology care.