# When AI and Experts Agree on Error: Intrinsic Ambiguity in Dermatoscopic Images

arXiv: https://arxiv.org/abs/2604.00651 · HTML: https://mlsanity.com/paper/2604.00651/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 10 of its 68 references that are in the map.
- First posted on arXiv 1 Apr 2026.

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

- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [A Survey on Deep Learning in Medical Image Analysis](https://mlsanity.com/paper/1702.05747/) (2017)
- [Skin Lesion Analysis Toward Melanoma Detection: A Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI), Hosted by the International Skin Imaging Collaboration (ISIC)](https://mlsanity.com/paper/1710.05006/) (2017)
- [Residual Attention Network for Image Classification](https://mlsanity.com/paper/1704.06904/) (2017)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [Evaluating Deep Neural Networks Trained on Clinical Images in Dermatology with the Fitzpatrick 17k Dataset](https://mlsanity.com/paper/2104.09957/) (2021)
- [SkinCon: A skin disease dataset densely annotated by domain experts for fine-grained model debugging and analysis](https://mlsanity.com/paper/2302.00785/) (2023)
- [Towards Transparency in Dermatology Image Datasets with Skin Tone Annotations by Experts, Crowds, and an Algorithm](https://mlsanity.com/paper/2207.02942/) (2022)
- [Clinical Melanoma Diagnosis with Artificial Intelligence: Insights from a Prospective Multicenter Study](https://mlsanity.com/paper/2401.14193/) (2024)

## Abstract (arXiv)

The integration of artificial intelligence (AI), particularly Convolutional Neural Networks (CNNs), into dermatological diagnosis demonstrates substantial clinical potential. While existing literature predominantly benchmarks algorithmic performance against human experts, our study adopts a novel perspective by investigating the intrinsic complexity of dermatoscopic images. Through rigorous experimentation with multiple CNN architectures, we isolated a subset of images systematically misclassified across all models-a phenomenon statistically proven to exceed random chance. To determine if these failures stem from algorithmic biases or inherent visual ambiguity, expert dermatologists independently evaluated these challenging cases alongside a control group. The results revealed a collapse in human diagnostic performance on the AI-misclassified images. First, agreement with ground-truth labels plummeted, with Cohen's kappa dropping to a mere 0.08 for the difficult images, compared to a 0.61 for the control group. Second, we observed a severe deterioration in expert consensus; inter-rater reliability among physicians fell from moderate concordance (Fleiss kappa = 0.456) on control images to only modest agreement (Fleiss kappa = 0.275) on difficult cases. We identified image quality as a primary driver of these dual systematic failures. To promote transparency and reproducibility, all data, code, and trained models have been made publicly available