# Disparities in Dermatology AI Performance on a Diverse, Curated Clinical Image Set

arXiv: https://arxiv.org/abs/2203.08807 · HTML: https://mlsanity.com/paper/2203.08807/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 59 references that are in the map.
- First posted on arXiv 15 Mar 2022.

## Builds on (most cited first, 10 of 10)

- [Adam: A Method for Stochastic Optimization](https://mlsanity.com/paper/1412.6980/) (2014)
- [Rethinking the Inception Architecture for Computer Vision](https://mlsanity.com/paper/1512.00567/) (2015)
- [mixup: Beyond Empirical Risk Minimization](https://mlsanity.com/paper/1710.09412/) (2017)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Deep CORAL: Correlation Alignment for Deep Domain Adaptation](https://mlsanity.com/paper/1607.01719/) (2016)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [How Does Mixup Help With Robustness and Generalization?](https://mlsanity.com/paper/2010.04819/) (2020)
- [Evaluating Deep Neural Networks Trained on Clinical Images in Dermatology with the Fitzpatrick 17k Dataset](https://mlsanity.com/paper/2104.09957/) (2021)
- [A deep learning system for differential diagnosis of skin diseases](https://mlsanity.com/paper/1909.05382/) (2019)
- [TrueImage: A Machine Learning Algorithm to Improve the Quality of Telehealth Photos](https://mlsanity.com/paper/2010.02086/) (2020)

## Abstract (arXiv)

Access to dermatological care is a major issue, with an estimated 3 billion people lacking access to care globally. Artificial intelligence (AI) may aid in triaging skin diseases. However, most AI models have not been rigorously assessed on images of diverse skin tones or uncommon diseases. To ascertain potential biases in algorithm performance in this context, we curated the Diverse Dermatology Images (DDI) dataset-the first publicly available, expertly curated, and pathologically confirmed image dataset with diverse skin tones. Using this dataset of 656 images, we show that state-of-the-art dermatology AI models perform substantially worse on DDI, with receiver operator curve area under the curve (ROC-AUC) dropping by 27-36 percent compared to the models' original test results. All the models performed worse on dark skin tones and uncommon diseases, which are represented in the DDI dataset. Additionally, we find that dermatologists, who typically provide visual labels for AI training and test datasets, also perform worse on images of dark skin tones and uncommon diseases compared to ground truth biopsy annotations. Finally, fine-tuning AI models on the well-characterized and diverse DDI images closed the performance gap between light and dark skin tones. Moreover, algorithms fine-tuned on diverse skin tones outperformed dermatologists on identifying malignancy on images of dark skin tones. Our findings identify important weaknesses and biases in dermatology AI that need to be addressed to ensure reliable application to diverse patients and diseases.