# The Impact of Skin Tone Label Granularity on the Performance and Fairness of AI Based Dermatology Image Classification Models

arXiv: https://arxiv.org/abs/2509.11184 · HTML: https://mlsanity.com/paper/2509.11184/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 9 of its 22 references that are in the map.
- First posted on arXiv 14 Sep 2025.

## Builds on (most cited first, 9 of 9)

- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [On Calibration of Modern Neural Networks](https://mlsanity.com/paper/1706.04599/) (2017)
- [Distributionally Robust Neural Networks for Group Shifts: On the Importance of Regularization for Worst-Case Generalization](https://mlsanity.com/paper/1911.08731/) (2019)
- [Evaluating Deep Neural Networks Trained on Clinical Images in Dermatology with the Fitzpatrick 17k Dataset](https://mlsanity.com/paper/2104.09957/) (2021)
- [Disparities in Dermatology AI: Assessments Using Diverse Clinical Images](https://mlsanity.com/paper/2111.08006/) (2021)
- [Fairness in Cardiac MR Image Analysis: An Investigation of Bias Due to Data Imbalance in Deep Learning Based Segmentation](https://mlsanity.com/paper/2106.12387/) (2021)
- [Improving the Fairness of Chest X-ray Classifiers](https://mlsanity.com/paper/2203.12609/) (2022)
- [CIRCLe: Color Invariant Representation Learning for Unbiased Classification of Skin Lesions](https://mlsanity.com/paper/2208.13528/) (2022)
- [Coarse race data conceals disparities in clinical risk score performance](https://mlsanity.com/paper/2304.09270/) (2023)

## Abstract (arXiv)

Artificial intelligence (AI) models to automatically classify skin lesions from dermatology images have shown promising performance but also susceptibility to bias by skin tone. The most common way of representing skin tone information is the Fitzpatrick Skin Tone (FST) scale. The FST scale has been criticised for having greater granularity in its skin tone categories for lighter-skinned subjects. This paper conducts an investigation of the impact (on performance and bias) on AI classification models of granularity in the FST scale. By training multiple AI models to classify benign vs. malignant lesions using FST-specific data of differing granularity, we show that: (i) when training models using FST-specific data based on three groups (FST 1/2, 3/4 and 5/6), performance is generally better for models trained on FST-specific data compared to a general model trained on FST-balanced data; (ii) reducing the granularity of FST scale information (from 1/2 and 3/4 to 1/2/3/4) can have a detrimental effect on performance. Our results highlight the importance of the granularity of FST groups when training lesion classification models. Given the question marks over possible human biases in the choice of categories in the FST scale, this paper provides evidence for a move away from the FST scale in fair AI research and a transition to an alternative scale that better represents the diversity of human skin tones.