# Artifact-Based Domain Generalization of Skin Lesion Models

arXiv: https://arxiv.org/abs/2208.09756 · HTML: https://mlsanity.com/paper/2208.09756/

## Key facts

- Cited by 11 papers in the map (data through 14 Oct 2026).
- Builds on 26 of its 43 references that are in the map.
- First posted on arXiv 20 Aug 2022.

## Builds on (most cited first, 26 of 26)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Encoder-Decoder with Atrous Separable Convolution for Semantic Image Segmentation](https://mlsanity.com/paper/1802.02611/) (2018)
- [Invariant Risk Minimization](https://mlsanity.com/paper/1907.02893/) (2019)
- [Inception-v4, Inception-ResNet and the Impact of Residual Connections on Learning](https://mlsanity.com/paper/1602.07261/) (2016)
- [Natural Adversarial Examples](https://mlsanity.com/paper/1907.07174/) (2019)
- [WILDS: A Benchmark of in-the-Wild Distribution Shifts](https://mlsanity.com/paper/2012.07421/) (2020)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [In Search of Lost Domain Generalization](https://mlsanity.com/paper/2007.01434/) (2020)
- [Domain Generalization: A Survey](https://mlsanity.com/paper/2103.02503/) (2021)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [Score-CAM: Score-Weighted Visual Explanations for Convolutional Neural Networks](https://mlsanity.com/paper/1910.01279/) (2019)
- [Fast Model Editing at Scale](https://mlsanity.com/paper/2110.11309/) (2021)
- [Towards Out-Of-Distribution Generalization: A Survey](https://mlsanity.com/paper/2108.13624/) (2021)
- [Self-Challenging Improves Cross-Domain Generalization](https://mlsanity.com/paper/2007.02454/) (2020)
- [The Pitfalls of Simplicity Bias in Neural Networks](https://mlsanity.com/paper/2006.07710/) (2020)
- [Environment Inference for Invariant Learning](https://mlsanity.com/paper/2010.07249/) (2020)
- [Gradient Starvation: A Learning Proclivity in Neural Networks](https://mlsanity.com/paper/2011.09468/) (2020)
- [The Risks of Invariant Risk Minimization](https://mlsanity.com/paper/2010.05761/) (2020)
- [PAD-UFES-20: a skin lesion dataset composed of patient data and clinical images collected from smartphones](https://mlsanity.com/paper/2007.00478/) (2020)
- [OoD-Bench: Quantifying and Understanding Two Dimensions of Out-of-Distribution Generalization](https://mlsanity.com/paper/2106.03721/) (2021)
- [Mitosis domain generalization in histopathology images -- The MIDOG challenge](https://mlsanity.com/paper/2204.03742/) (2022)
- [Editing a classifier by rewriting its prediction rules](https://mlsanity.com/paper/2112.01008/) (2021)
- [Debiasing Skin Lesion Datasets and Models? Not So Fast](https://mlsanity.com/paper/2004.11457/) (2020)
- [(De)Constructing Bias on Skin Lesion Datasets](https://mlsanity.com/paper/1904.08818/) (2019)
- [The (de)biasing effect of GAN-based augmentation methods on skin lesion images](https://mlsanity.com/paper/2206.15182/) (2022)
- [Contemplating real-world object classification](https://mlsanity.com/paper/2103.05137/) (2021)

## Built on by (most cited first, 11 of 11)

- [Domain Generalization for Medical Image Analysis: A Review](https://mlsanity.com/paper/2310.08598/) (2023)
- [EPVT: Environment-aware Prompt Vision Transformer for Domain Generalization in Skin Lesion Recognition](https://mlsanity.com/paper/2304.01508/) (2023)
- [Even Small Correlation and Diversity Shifts Pose Dataset-Bias Issues](https://mlsanity.com/paper/2305.05807/) (2023)
- [Prompt-driven Latent Domain Generalization for Medical Image Classification](https://mlsanity.com/paper/2401.03002/) (2024)
- [A Systematic Review of Generalization Research in Medical Image Classification](https://mlsanity.com/paper/2403.12167/) (2024)
- [Diffusion Model Driven Test-Time Image Adaptation for Robust Skin Lesion Classification](https://mlsanity.com/paper/2405.11289/) (2024)
- [Test-Time Selection for Robust Skin Lesion Analysis](https://mlsanity.com/paper/2308.05595/) (2023)
- [Improving Artifact Robustness for CT Deep Learning Models Without Labeled Artifact Images via Domain Adaptation](https://mlsanity.com/paper/2510.06584/) (2025)
- [Are Explanations Helpful? A Comparative Analysis of Explainability Methods in Skin Lesion Classifiers](https://mlsanity.com/paper/2412.03166/) (2024)
- [Language-Guided Trajectory Traversal in Disentangled Stable Diffusion Latent Space for Factorized Medical Image Generation](https://mlsanity.com/paper/2503.23623/) (2025)
- [A Causal Framework for Mitigating Data Shifts in Healthcare](https://mlsanity.com/paper/2603.13595/) (2026)

## Abstract (arXiv)

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.