# Skin-R1: Clinical Knowledge-Guided Dermatological Diagnosis Using Vision-Language Models

arXiv: https://arxiv.org/abs/2511.14900 · HTML: https://mlsanity.com/paper/2511.14900/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- Placed in Medical vision-language models, one of 16 directions in Multimodal LLMs / vision-language models.
- Builds on 28 of its 73 references that are in the map.
- First posted on arXiv 18 Nov 2025.

## Placed in

- Multimodal LLMs / vision-language models / [Medical vision-language models](https://mlsanity.com/mllm/medical-vision-language-models/)

## Builds on (most cited first, 28 of 28)

- [LLaMA: Open and Efficient Foundation Language Models](https://mlsanity.com/paper/2302.13971/) (2023)
- [DeepSeekMath: Pushing the Limits of Mathematical Reasoning in Open Language Models](https://mlsanity.com/paper/2402.03300/) (2024)
- [Visual Instruction Tuning](https://mlsanity.com/paper/2304.08485/) (2023)
- [Qwen2.5-VL Technical Report](https://mlsanity.com/paper/2502.13923/) (2025)
- [MiniGPT-4: Enhancing Vision-Language Understanding with Advanced Large Language Models](https://mlsanity.com/paper/2304.10592/) (2023)
- [InternVL3: Exploring Advanced Training and Test-Time Recipes for Open-Source Multimodal Models](https://mlsanity.com/paper/2504.10479/) (2025)
- [A Survey on Multimodal Large Language Models](https://mlsanity.com/paper/2306.13549/) (2023)
- [Gemini: A Family of Highly Capable Multimodal Models](https://mlsanity.com/paper/2312.11805/) (2023)
- [Measuring Faithfulness in Chain-of-Thought Reasoning](https://mlsanity.com/paper/2307.13702/) (2023)
- [Skin Lesion Analysis Toward Melanoma Detection 2018: A Challenge Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1902.03368/) (2019)
- [MedGemma Technical Report](https://mlsanity.com/paper/2507.05201/) (2025)
- [R1-VL: Learning to Reason with Multimodal Large Language Models via Step-wise Group Relative Policy Optimization](https://mlsanity.com/paper/2503.12937/) (2025)
- [Logic-RL: Unleashing LLM Reasoning with Rule-Based Reinforcement Learning](https://mlsanity.com/paper/2502.14768/) (2025)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [HuatuoGPT-Vision, Towards Injecting Medical Visual Knowledge into Multimodal LLMs at Scale](https://mlsanity.com/paper/2406.19280/) (2024)
- [Med-R1: Reinforcement Learning for Generalizable Medical Reasoning in Vision-Language Models](https://mlsanity.com/paper/2503.13939/) (2025)
- [A Survey of Large Language Models in Medicine: Progress, Application, and Challenge](https://mlsanity.com/paper/2311.05112/) (2023)
- [A Comprehensive Survey in LLM(-Agent) Full Stack Safety: Data, Training and Deployment](https://mlsanity.com/paper/2504.15585/) (2025)
- [HealthGPT: A Medical Large Vision-Language Model for Unifying Comprehension and Generation via Heterogeneous Knowledge Adaptation](https://mlsanity.com/paper/2502.09838/) (2025)
- [XrayGPT: Chest Radiographs Summarization using Medical Vision-Language Models](https://mlsanity.com/paper/2306.07971/) (2023)
- [Enigmata: Scaling Logical Reasoning in Large Language Models with Synthetic Verifiable Puzzles](https://mlsanity.com/paper/2505.19914/) (2025)
- [Beyond 'Aha!': Toward Systematic Meta-Abilities Alignment in Large Reasoning Models](https://mlsanity.com/paper/2505.10554/) (2025)
- [OmniV-Med: Scaling Medical Vision-Language Model for Universal Visual Understanding](https://mlsanity.com/paper/2504.14692/) (2025)
- [Improving Medical Reasoning with Curriculum-Aware Reinforcement Learning](https://mlsanity.com/paper/2505.19213/) (2025)
- [MAKE: Multi-Aspect Knowledge-Enhanced Vision-Language Pretraining for Zero-shot Dermatological Assessment](https://mlsanity.com/paper/2505.09372/) (2025)
- [RARL: Improving Medical VLM Reasoning and Generalization with Reinforcement Learning and LoRA under Data and Hardware Constraints](https://mlsanity.com/paper/2506.06600/) (2025)
- [Toward Effective Reinforcement Learning Fine-Tuning for Medical VQA in Vision-Language Models](https://mlsanity.com/paper/2505.13973/) (2025)
- [A Comprehensive Survey of Electronic Health Record Modeling: From Deep Learning Approaches to Large Language Models](https://mlsanity.com/paper/2507.12774/) (2025)

## Built on by (most cited first, 4 of 4)

- [DermoGPT: Open Weights and Open Data for Morphology-Grounded Dermatological Reasoning MLLMs](https://mlsanity.com/paper/2601.01868/) (2026)
- [Regulating Anatomy-Aware Rewards via Trajectory-Integral Feedback for Volumetric Computed Tomography Analysis](https://mlsanity.com/paper/2605.20277/) (2026)
- [Are Multimodal LLMs Ready for Clinical Dermatology? A Real-World Evaluation in Dermatology](https://mlsanity.com/paper/2605.04098/) (2026)
- [Reasoning4Sciences: Bridging Reasoning Language Models to All Scientific Branches](https://mlsanity.com/paper/2606.01145/) (2026)

## Abstract (arXiv)

Vision--language models (VLMs) have recently shown promise for assisting clinical reasoning in dermatological diagnosis. However, their trustworthiness and clinical utility remain limited by three key challenges: heterogeneous datasets with inconsistent diagnostic labels and concept annotations, the lack of grounded diagnostic rationales for reliable reasoning supervision, and limited scalability when transferring knowledge from small, densely annotated datasets to large collections with sparse labels. To address these challenges, we propose Skin-R1, a dermatology-oriented VLM that integrates textbook-grounded clinical reasoning supervision with reinforcement learning (RL) to improve the accuracy and robustness of diagnostic prediction. First, we construct a textbook-based reasoning generator that synthesizes hierarchy-aware and differential-diagnosis (DDx) diagnostic trajectories derived from authoritative dermatology knowledge. Second, these trajectories are used for supervised fine-tuning (SFT), establishing a clinically grounded reasoning foundation for the model. Finally, we introduce an RL training framework that incorporates the hierarchical structure of dermatological diseases into the reward design, enabling the model to generalize grounded diagnostic reasoning to large-scale datasets with sparse annotations. Extensive experiments across multiple dermatology benchmarks demonstrate that Skin-R1 consistently improves diagnostic accuracy and robustness compared to state-of-the-art Med-VLM baselines. Ablation studies further highlight the critical role of grounded reasoning supervision introduced during the SFT stage.