Automated color calibration method for dermoscopy images

Concordance and Accuracy of Teledermatology Using Mobile Phones in the Outpatient Clinic of Jose R Reyes Memorial Medical Center: Cross-sectional Study

BACKGROUND

Dermatologists rely on visual findings; thus, teledermatology is uniquely compatible to providing dermatologic care. The use of mobile phones in a store-and-forward approach, where gathered data are sent to a distant health provider for later review, may be a potential bridge in seeking dermatologic care.

OBJECTIVE

This study aimed to determine the agreement between face-to-face consultations and teledermatologic consultations through the store-and-forward approach using mobile phones and its accuracy compared to a histopathologic diagnosis.

METHODS

The study design was a cross-sectional study of participants consecutively recruited from dermatology patients who presented with skin or mucosal complaint and without prior dermatologist consultation. Photographs were taken using a standard smartphone (iPhone 6s Plus), and a 4-mm skin punch biopsy was taken on each patient-the gold standard to which the study result was compared to. The photographs were sent to 3 consultant dermatologists using a store-and-forward approach, for independent diagnosis and treatment plan.

RESULTS

A total of 60 patients were included, with a median age of 41 years. There was moderate-to-almost perfect agreement in terms of final diagnosis between the face-to-face dermatologic diagnosis and teledermatologic diagnoses. The third teledermatologist had the highest agreement with the clinical dermatologist in terms of final diagnosis (κ=0.84; P<.001). Among the 3 dermatologists, there was moderate-to-almost perfect agreement as well. Agreement between pairs of teledermatologists ranged from 0.45 to 0.84. The 3 teledermatologists had moderate-to-substantial agreement with the biopsy results, with the third teledermatologist having the highest accuracy (κ=0.77; P<.001). Overall, there was a moderate agreement in the diagnosis of patients across raters.

CONCLUSIONS

Teledermatology is a viable alternative to face-to-face consultations. Our results show moderate-to-substantial agreement in diagnoses from a face-to-face consultation and store-and-forward teledermatology.

Deep Learning Approaches Towards Skin Lesion Segmentation and Classification from Dermoscopic Images - A Review

BACKGROUND

Automated intelligent systems for unbiased diagnosis are primary requirement for the pigment lesion analysis. It has gained the attention of researchers in the last few decades. These systems involve multiple phases such as pre-processing, feature extraction, segmentation, classification and post processing. It is crucial to accurately localize and segment the skin lesion. It is observed that recent enhancements in machine learning algorithms and dermoscopic techniques reduced the misclassification rate therefore, the focus towards computer aided systems increased exponentially in recent years. Computer aided diagnostic systems are reliable source for dermatologists to analyze the type of cancer, but it is widely acknowledged that even higher accuracy is needed for computer aided diagnostic systems to be adopted practically in the diagnostic process of life threatening diseases.

INTRODUCTION

Skin cancer is one of the most threatening cancers. It occurs by the abnormal multiplication of cells. The core three types of skin cells are: Squamous, Basal and Melanocytes. There are two wide classes of skin cancer; Melanocytic and non-Melanocytic. It is difficult to differentiate between benign and malignant melanoma, therefore dermatologists sometimes misclassify the benign and malignant melanoma. Melanoma is estimated as 19th most frequent cancer, it is riskier than the Basel and Squamous carcinoma because it rapidly spreads throughout the body. Hence, to lower the death risk, it is critical to diagnose the correct type of cancer in early rudimentary phases. It can occur on any part of body, but it has higher probability to occur on chest, back and legs.

METHODS

The paper presents a review of segmentation and classification techniques for skin lesion detection. Dermoscopy and its features are discussed briefly. After that Image pre-processing techniques are described. A thorough review of segmentation and classification phases of skin lesion detection using deep learning techniques is presented Literature is discussed and a comparative analysis of discussed methods is presented.

CONCLUSION

In this paper, we have presented the survey of more than 100 papers and comparative analysis of state of the art techniques, model and methodologies. Malignant melanoma is one of the most threating and deadliest cancers. Since the last few decades, researchers are putting extra attention and effort in accurate diagnosis of melanoma. The main challenges of dermoscopic skin lesion images are: low contrasts, multiple lesions, irregular and fuzzy borders, blood vessels, regression, hairs, bubbles, variegated coloring and other kinds of distortions. The lack of large training dataset makes these problems even more challenging. Due to recent advancement in the paradigm of deep learning, and specially the outstanding performance in medical imaging, it has become important to review the deep learning algorithms performance in skin lesion segmentation. Here, we have discussed the results of different techniques on the basis of different evaluation parameters such as Jaccard coefficient, sensitivity, specificity and accuracy. And the paper listed down the major achievements in this domain with the detailed discussion of the techniques. In future, it is expected to improve results by utilizing the capabilities of deep learning frameworks with other pre and post processing techniques so reliable and accurate diagnostic systems can be built.

Melanoma Skin Cancer Detection Method Based on Adaptive Principal Curvature, Colour Normalisation and Feature Extraction with the ABCD Rule

According to statistics of the American Cancer Society, in 2015, there are about 91,270 American adults diagnosed with melanoma of the skin. For the European Union, there are over 90,000 new cases of melanoma annually. Although melanoma only accounts for about 1% of all skin cancers, it causes most of the skin cancer deaths. Melanoma is considered one of the fastest-growing forms of skin cancer, and hence the early detection is crucial, as early detection is helpful and can provide strong recommendations for specific and suitable treatment regimens. In this work, we propose a method to detect melanoma skin cancer with automatic image processing techniques. Our method includes three stages: pre-process images of skin lesions by adaptive principal curvature, segment skin lesions by the colour normalisation and extract features by the ABCD rule. We provide experimental results of the proposed method on the publicly available International Skin Imaging Collaboration (ISIC) skin lesions dataset. The acquired results on melanoma skin cancer detection indicates that the proposed method has high accuracy, and overall, a good performance: for the segmentation stage, the accuracy, Dice, Jaccard scores are 96.6%, 93.9% and 88.7%, respectively; and for the melanoma detection stage, the accuracy is up to 100% for a selected subset of the ISIC dataset.

Image Quality Assessment of Digital Image Capturing Devices for Melanoma Detection

The fast-growing incidence of skin cancer, especially melanoma, is the guiding principle for intense development of various digital image-capturing devices providing easier recognition of melanoma by dermatologists. Handheld and digital dermoscopy, following of mole changes with smartphones and digital analysing of mole images, is based on evaluation of the colours, shape and deep structures in the skin moles. Incorrect colour information of an image, under- or overexposed images, lack of sharpness and low resolution of the images, can lead to melanoma misdiagnosis. The purpose of our study was to determine the colour error in the image according to the given lighting conditions and different camera settings. We focused on measuring the image quality parameters of smartphones and high-resolution cameras to compare them with the results of state-of-the-art dermoscopy device systems. We applied standardised measuring methods. The spatial frequency response method was applied for measuring the sharpness and resolution of the tested camera systems. Colour images with known reference values were captured from the test target, to evaluate colour error as a CIELAB (Commission Internationale de l’Eclairage) ΔE*ab colour difference as seen by a human observer. The results of our measurements yielded two significant findings. First, all tested cameras produced inaccurate colours when operating in automatic mode, and second, the amount of sharpening was too intensive. These deficiencies can be eliminated through adjusting the camera parameters manually or by image post-production. The presented two-step camera calibration procedure improves the colour accuracy of captured clinical and dermoscopy images significantly.

Computer-assisted diagnosis techniques (dermoscopy and spectroscopy-based) for diagnosing skin cancer in adults

BACKGROUND

Early accurate detection of all skin cancer types is essential to guide appropriate management and to improve morbidity and survival. Melanoma and cutaneous squamous cell carcinoma (cSCC) are high-risk skin cancers which have the potential to metastasise and ultimately lead to death, whereas basal cell carcinoma (BCC) is usually localised with potential to infiltrate and damage surrounding tissue. Anxiety around missing early curable cases needs to be balanced against inappropriate referral and unnecessary excision of benign lesions. Computer-assisted diagnosis (CAD) systems use artificial intelligence to analyse lesion data and arrive at a diagnosis of skin cancer. When used in unreferred settings ('primary care'), CAD may assist general practitioners (GPs) or other clinicians to more appropriately triage high-risk lesions to secondary care. Used alongside clinical and dermoscopic suspicion of malignancy, CAD may reduce unnecessary excisions without missing melanoma cases.

OBJECTIVES

To determine the accuracy of CAD systems for diagnosing cutaneous invasive melanoma and atypical intraepidermal melanocytic variants, BCC or cSCC in adults, and to compare its accuracy with that of dermoscopy.

SEARCH METHODS

We undertook a comprehensive search of the following databases from inception up to August 2016: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE; Embase; CINAHL; CPCI; Zetoc; Science Citation Index; US National Institutes of Health Ongoing Trials Register; NIHR Clinical Research Network Portfolio Database; and the World Health Organization International Clinical Trials Registry Platform. We studied reference lists and published systematic review articles.

SELECTION CRITERIA

Studies of any design that evaluated CAD alone, or in comparison with dermoscopy, in adults with lesions suspicious for melanoma or BCC or cSCC, and compared with a reference standard of either histological confirmation or clinical follow-up.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted all data using a standardised data extraction and quality assessment form (based on QUADAS-2). We contacted authors of included studies where information related to the target condition or diagnostic threshold were missing. We estimated summary sensitivities and specificities separately by type of CAD system, using the bivariate hierarchical model. We compared CAD with dermoscopy using (a) all available CAD data (indirect comparisons), and (b) studies providing paired data for both tests (direct comparisons). We tested the contribution of human decision-making to the accuracy of CAD diagnoses in a sensitivity analysis by removing studies that gave CAD results to clinicians to guide diagnostic decision-making.

MAIN RESULTS

We included 42 studies, 24 evaluating digital dermoscopy-based CAD systems (Derm-CAD) in 23 study cohorts with 9602 lesions (1220 melanomas, at least 83 BCCs, 9 cSCCs), providing 32 datasets for Derm-CAD and seven for dermoscopy. Eighteen studies evaluated spectroscopy-based CAD (Spectro-CAD) in 16 study cohorts with 6336 lesions (934 melanomas, 163 BCC, 49 cSCCs), providing 32 datasets for Spectro-CAD and six for dermoscopy. These consisted of 15 studies using multispectral imaging (MSI), two studies using electrical impedance spectroscopy (EIS) and one study using diffuse-reflectance spectroscopy. Studies were incompletely reported and at unclear to high risk of bias across all domains. Included studies inadequately address the review question, due to an abundance of low-quality studies, poor reporting, and recruitment of highly selected groups of participants.Across all CAD systems, we found considerable variation in the hardware and software technologies used, the types of classification algorithm employed, methods used to train the algorithms, and which lesion morphological features were extracted and analysed across all CAD systems, and even between studies evaluating CAD systems. Meta-analysis found CAD systems had high sensitivity for correct identification of cutaneous invasive melanoma and atypical intraepidermal melanocytic variants in highly selected populations, but with low and very variable specificity, particularly for Spectro-CAD systems. Pooled data from 22 studies estimated the sensitivity of Derm-CAD for the detection of melanoma as 90.1% (95% confidence interval (CI) 84.0% to 94.0%) and specificity as 74.3% (95% CI 63.6% to 82.7%). Pooled data from eight studies estimated the sensitivity of multispectral imaging CAD (MSI-CAD) as 92.9% (95% CI 83.7% to 97.1%) and specificity as 43.6% (95% CI 24.8% to 64.5%). When applied to a hypothetical population of 1000 lesions at the mean observed melanoma prevalence of 20%, Derm-CAD would miss 20 melanomas and would lead to 206 false-positive results for melanoma. MSI-CAD would miss 14 melanomas and would lead to 451 false diagnoses for melanoma. Preliminary findings suggest CAD systems are at least as sensitive as assessment of dermoscopic images for the diagnosis of invasive melanoma and atypical intraepidermal melanocytic variants. We are unable to make summary statements about the use of CAD in unreferred populations, or its accuracy in detecting keratinocyte cancers, or its use in any setting as a diagnostic aid, because of the paucity of studies.

AUTHORS' CONCLUSIONS

In highly selected patient populations all CAD types demonstrate high sensitivity, and could prove useful as a back-up for specialist diagnosis to assist in minimising the risk of missing melanomas. However, the evidence base is currently too poor to understand whether CAD system outputs translate to different clinical decision-making in practice. Insufficient data are available on the use of CAD in community settings, or for the detection of keratinocyte cancers. The evidence base for individual systems is too limited to draw conclusions on which might be preferred for practice. Prospective comparative studies are required that evaluate the use of already evaluated CAD systems as diagnostic aids, by comparison to face-to-face dermoscopy, and in participant populations that are representative of those in which the test would be used in practice.

Automatic differentiation of melanoma from dysplastic nevi

Malignant melanoma causes the majority of deaths related to skin cancer. Nevertheless, it is the most treatable one, depending on its early diagnosis. The early prognosis is a challenging task for both clinicians and dermatologist, due to the characteristic similarities of melanoma with other skin lesions such as dysplastic nevi. In the past decades, several computerized lesion analysis algorithms have been proposed by the research community for detection of melanoma. These algorithms mostly focus on differentiating melanoma from benign lesions and few have considered the case of melanoma against dysplastic nevi. In this paper, we consider the most challenging task and propose an automatic framework for differentiation of melanoma from dysplastic nevi. The proposed framework also considers combination and comparison of several texture features beside the well used colour and shape features based on "ABCD" clinical rule in the literature. Focusing on dermoscopy images, we evaluate the performance of the framework using two feature extraction approaches, global and local (bag of words) and three classifiers such as support vector machine, gradient boosting and random forest. Our evaluation revealed the potential of texture features and random forest as an almost independent classifier. Using texture features and random forest for differentiation of melanoma and dysplastic nevi, the framework achieved the highest sensitivity of 98% and specificity of 70%.

Segmentation of skin lesions from digital images using joint statistical texture distinctiveness

Melanoma is the deadliest form of skin cancer. Incidence rates of melanoma have been increasing, especially among non-Hispanic white males and females, but survival rates are high if detected early. Due to the costs for dermatologists to screen every patient, there is a need for an automated system to assess a patient's risk of melanoma using images of their skin lesions captured using a standard digital camera. One challenge in implementing such a system is locating the skin lesion in the digital image. A novel texture-based skin lesion segmentation algorithm is proposed. A set of representative texture distributions are learned from an illumination-corrected photograph and a texture distinctiveness metric is calculated for each distribution. Next, regions in the image are classified as normal skin or lesion based on the occurrence of representative texture distributions. The proposed segmentation framework is tested by comparing lesion segmentation results and melanoma classification results to results using other state-of-art algorithms. The proposed framework has higher segmentation accuracy compared to all other tested algorithms.

Improving dermoscopy image classification using color constancy

Robustness is one of the most important characteristics of computer-aided diagnosis systems designed for dermoscopy images. However, it is difficult to ensure this characteristic if the systems operate with multisource images acquired under different setups. Changes in the illumination and acquisition devices alter the color of images and often reduce the performance of the systems. Thus, it is important to normalize the colors of dermoscopy images before training and testing any system. In this paper, we investigate four color constancy algorithms: Gray World, max-RGB, Shades of Gray, and General Gray World. Our results show that color constancy improves the classification of multisource images, increasing the sensitivity of a bag-of-features system from 71.0% to 79.7% and the specificity from 55.2% to 76% using only 1-D RGB histograms as features.