XAI for Skin Cancer Detection with Prototypes and Non-Expert Supervision

Skin cancer detection through dermoscopy image analysis is a critical task. However, existing models used for this purpose often lack interpretability and reliability, raising the concern of physicians due to their black-box nature. In this paper, we propose a novel approach for the diagnosis of melanoma using an interpretable prototypical-part model. We introduce a guided supervision based on non-expert feedback through the incorporation of: 1) binary masks, obtained automatically using a segmentation network; and 2) user-refined prototypes. These two distinct information pathways aim to ensure that the learned prototypes correspond to relevant areas within the skin lesion, excluding confounding factors beyond its boundaries. Experimental results demonstrate that, even without expert supervision, our approach achieves superior performance and generalization compared to non-interpretable models.

The Performance of Transferability Metrics does not Translate to Medical Tasks

Transfer learning boosts the performance of medical image analysis by enabling deep learning (DL) on small datasets through the knowledge acquired from large ones. As the number of DL architectures explodes, exhaustively attempting all candidates becomes unfeasible, motivating cheaper alternatives for choosing them. Transferability scoring methods emerge as an enticing solution, allowing to efficiently calculate a score that correlates with the architecture accuracy on any target dataset. However, since transferability scores have not been evaluated on medical datasets, their use in this context remains uncertain, preventing them from benefiting practitioners. We fill that gap in this work, thoroughly evaluating seven transferability scores in three medical applications, including out-of-distribution scenarios. Despite promising results in general-purpose datasets, our results show that no transferability score can reliably and consistently estimate target performance in medical contexts, inviting further work in that direction.

Test-Time Selection for Robust Skin Lesion Analysis

Skin lesion analysis models are biased by artifacts placed during image acquisition, which influence model predictions despite carrying no clinical information. Solutions that address this problem by regularizing models to prevent learning those spurious features achieve only partial success, and existing test-time debiasing techniques are inappropriate for skin lesion analysis due to either making unrealistic assumptions on the distribution of test data or requiring laborious annotation from medical practitioners. We propose TTS (Test-Time Selection), a human-in-the-loop method that leverages positive (e.g., lesion area) and negative (e.g., artifacts) keypoints in test samples. TTS effectively steers models away from exploiting spurious artifact-related correlations without retraining, and with less annotation requirements. Our solution is robust to a varying availability of annotations, and different levels of bias. We showcase on the ISIC2019 dataset (for which we release a subset of annotated images) how our model could be deployed in the real-world for mitigating bias.

Even Small Correlation and Diversity Shifts Pose Dataset-Bias Issues

Distribution shifts are common in real-world datasets and can affect the performance and reliability of deep learning models. In this paper, we study two types of distribution shifts: diversity shifts, which occur when test samples exhibit patterns unseen during training, and correlation shifts, which occur when test data present a different correlation between seen invariant and spurious features. We propose an integrated protocol to analyze both types of shifts using datasets where they co-exist in a controllable manner. Finally, we apply our approach to a real-world classification problem of skin cancer analysis, using out-of-distribution datasets and specialized bias annotations. Our protocol reveals three findings: 1) Models learn and propagate correlation shifts even with low-bias training; this poses a risk of accumulating and combining unaccountable weak biases; 2) Models learn robust features in high- and low-bias scenarios but use spurious ones if test samples have them; this suggests that spurious correlations do not impair the learning of robust features; 3) Diversity shift can reduce the reliance on spurious correlations; this is counter intuitive since we expect biased models to depend more on biases when invariant features are missing. Our work has implications for distribution shift research and practice, providing new insights into how models learn and rely on spurious correlations under different types of shifts.

Artifact-Based Domain Generalization of Skin Lesion Models

Deep Learning failure cases are abundant, particularly in the medical area. Recent studies in out-of-distribution generalization have advanced considerably on well-controlled synthetic datasets, but they do not represent medical imaging contexts. We propose a pipeline that relies on artifacts annotation to enable generalization evaluation and debiasing for the challenging skin lesion analysis context. First, we partition the data into levels of increasingly higher biased training and test sets for better generalization assessment. Then, we create environments based on skin lesion artifacts to enable domain generalization methods. Finally, after robust training, we perform a test-time debiasing procedure, reducing spurious features in inference images. Our experiments show our pipeline improves performance metrics in biased cases, and avoids artifacts when using explanation methods. Still, when evaluating such models in out-of-distribution data, they did not prefer clinically-meaningful features. Instead, performance only improved in test sets that present similar artifacts from training, suggesting models learned to ignore the known set of artifacts. Our results raise a concern that debiasing models towards a single aspect may not be enough for fair skin lesion analysis.

A Survey on Deep Learning for Skin Lesion Segmentation

Skin cancer is a major public health problem that could benefit from computer-aided diagnosis to reduce the burden of this common disease. Skin lesion segmentation from images is an important step toward achieving this goal. However, the presence of natural and artificial artifacts (e.g., hair and air bubbles), intrinsic factors (e.g., lesion shape and contrast), and variations in image acquisition conditions make skin lesion segmentation a challenging task. Recently, various researchers have explored the applicability of deep learning models to skin lesion segmentation. In this survey, we cross-examine 134 research papers that deal with deep learning based segmentation of skin lesions. We analyze these works along several dimensions, including input data (datasets, preprocessing, and synthetic data generation), model design (architecture, modules, and losses), and evaluation aspects (data annotation requirements and segmentation performance). We discuss these dimensions both from the viewpoint of select seminal works, and from a systematic viewpoint, examining how those choices have influenced current trends, and how their limitations should be addressed. We summarize all examined works in a comprehensive table to facilitate comparisons.

An Evaluation of Self-Supervised Pre-Training for Skin-Lesion Analysis

Self-supervised pre-training appears as an advantageous alternative to supervised pre-trained for transfer learning. By synthesizing annotations on pretext tasks, self-supervision allows to pre-train models on large amounts of pseudo-labels before fine-tuning them on the target task. In this work, we assess self-supervision for the diagnosis of skin lesions, comparing three self-supervised pipelines to a challenging supervised baseline, on five test datasets comprising in- and out-of-distribution samples. Our results show that self-supervision is competitive both in improving accuracies and in reducing the variability of outcomes. Self-supervision proves particularly useful for low training data scenarios ($<1\,500$ and $<150$ samples), where its ability to stabilize the outcomes is essential to provide sound results.

GAN-Based Data Augmentation and Anonymization for Skin-Lesion Analysis: A Critical Review

Despite the growing availability of high-quality public datasets, the lack of training samples is still one of the main challenges of deep-learning for skin lesion analysis. Generative Adversarial Networks (GANs) appear as an enticing alternative to alleviate the issue, by synthesizing samples indistinguishable from real images, with a plethora of works employing them for medical applications. Nevertheless, carefully designed experiments for skin-lesion diagnosis with GAN-based data augmentation show favorable results only on out-of-distribution test sets. For GAN-based data anonymization $-$ where the synthetic images replace the real ones $-$ favorable results also only appear for out-of-distribution test sets. Because of the costs and risks associated with GAN usage, those results suggest caution in their adoption for medical applications.

Debiasing Skin Lesion Datasets and Models? Not So Fast

Data-driven models are now deployed in a plethora of real-world applications - including automated diagnosis - but models learned from data risk learning biases from that same data. When models learn spurious correlations not found in real-world situations, their deployment for critical tasks, such as medical decisions, can be catastrophic. In this work we address this issue for skin-lesion classification models, with two objectives: finding out what are the spurious correlations exploited by biased networks, and debiasing the models by removing such spurious correlations from them. We perform a systematic integrated analysis of 7 visual artifacts (which are possible sources of biases exploitable by networks), employ a state-of-the-art technique to prevent the models from learning spurious correlations, and propose datasets to test models for the presence of bias. We find out that, despite interesting results that point to promising future research, current debiasing methods are not ready to solve the bias issue for skin-lesion models.