# Concept Inconsistency in Dermoscopic Concept Bottleneck Models: A Rough-Set Analysis of the Derm7pt Dataset

arXiv: https://arxiv.org/abs/2604.19323 · HTML: https://mlsanity.com/paper/2604.19323/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 27 of its 51 references that are in the map.
- First posted on arXiv 21 Apr 2026.

## Builds on (most cited first, 27 of 27)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [Grad-CAM: Visual Explanations from Deep Networks via Gradient-based Localization](https://mlsanity.com/paper/1610.02391/) (2016)
- [Densely Connected Convolutional Networks](https://mlsanity.com/paper/1608.06993/) (2016)
- [A Unified Approach to Interpreting Model Predictions](https://mlsanity.com/paper/1705.07874/) (2017)
- [EfficientNet: Rethinking Model Scaling for Convolutional Neural Networks](https://mlsanity.com/paper/1905.11946/) (2019)
- ["Why Should I Trust You?": Explaining the Predictions of Any Classifier](https://mlsanity.com/paper/1602.04938/) (2016)
- [Wide Residual Networks](https://mlsanity.com/paper/1605.07146/) (2016)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [Post-hoc Concept Bottleneck Models](https://mlsanity.com/paper/2205.15480/) (2022)
- [Label-Free Concept Bottleneck Models](https://mlsanity.com/paper/2304.06129/) (2023)
- [BCN20000: Dermoscopic Lesions in the Wild](https://mlsanity.com/paper/1908.02288/) (2019)
- [Axiom-based Grad-CAM: Towards Accurate Visualization and Explanation of CNNs](https://mlsanity.com/paper/2008.02312/) (2020)
- [A Patient-Centric Dataset of Images and Metadata for Identifying Melanomas Using Clinical Context](https://mlsanity.com/paper/2008.07360/) (2020)
- [Promises and Pitfalls of Black-Box Concept Learning Models](https://mlsanity.com/paper/2106.13314/) (2021)
- [Use HiResCAM instead of Grad-CAM for faithful explanations of convolutional neural networks](https://mlsanity.com/paper/2011.08891/) (2020)
- [A Closer Look at the Intervention Procedure of Concept Bottleneck Models](https://mlsanity.com/paper/2302.14260/) (2023)
- [Logic Explained Networks](https://mlsanity.com/paper/2108.05149/) (2021)
- [On Interpretability of Deep Learning based Skin Lesion Classifiers using Concept Activation Vectors](https://mlsanity.com/paper/2005.02000/) (2020)
- [Human Uncertainty in Concept-Based AI Systems](https://mlsanity.com/paper/2303.12872/) (2023)
- [Coherent Concept-based Explanations in Medical Image and Its Application to Skin Lesion Diagnosis](https://mlsanity.com/paper/2304.04579/) (2023)
- [ExAID: A Multimodal Explanation Framework for Computer-Aided Diagnosis of Skin Lesions](https://mlsanity.com/paper/2201.01249/) (2022)
- [MICA: Towards Explainable Skin Lesion Diagnosis via Multi-Level Image-Concept Alignment](https://mlsanity.com/paper/2401.08527/) (2024)
- [Concept Bottleneck Models Without Predefined Concepts](https://mlsanity.com/paper/2407.03921/) (2024)
- [Concept-Attention Whitening for Interpretable Skin Lesion Diagnosis](https://mlsanity.com/paper/2404.05997/) (2024)
- [DERM12345: A Large, Multisource Dermatoscopic Skin Lesion Dataset with 38 Subclasses](https://mlsanity.com/paper/2406.07426/) (2024)
- [An Analysis of Concept Bottleneck Models: Measuring, Understanding, and Mitigating the Impact of Noisy Annotations](https://mlsanity.com/paper/2505.16705/) (2025)
- [Dermatologist-like explainable AI enhances melanoma diagnosis accuracy: eye-tracking study](https://mlsanity.com/paper/2409.13476/) (2024)

## Abstract (arXiv)

Concept Bottleneck Models (CBMs) route predictions exclusively through a clinically grounded concept layer, binding interpretability to concept-label consistency. When a dataset contains concept-level inconsistencies, identical concept profiles mapped to conflicting diagnosis labels create an unresolvable bottleneck that imposes a hard ceiling on achievable accuracy. In this paper, we apply rough set theory to the Derm7pt dermoscopy benchmark and characterize the full extent and clinical structure of this inconsistency. Among 305 unique concept profiles formed by the 7 dermoscopic criteria of the 7-point melanoma checklist, 50 (16.4%) are inconsistent, spanning 306 images (30.3% of the dataset). This yields a theoretical accuracy ceiling of 92.1%, independent of backbone architecture or training strategy for CBMs that exclusively operate with hard concepts. In addition, we characterize the conflict-severity distribution, identify the clinical features most responsible for boundary ambiguity, and evaluate two filtering strategies with quantified effects on dataset composition and CBM interpretability. Symmetric removal of all boundary-region images yields Derm7pt+, a fully consistent benchmark subset of 705 images with perfect quality of classification and no hard accuracy ceiling. Building on this filtered dataset, we present a hard CBM evaluated across 19 backbone architectures from the EfficientNet, DenseNet, ResNet, and Wide ResNet families. Under symmetric filtering, explored for completeness, EfficientNet-B5 achieves the best label F1 score (0.85) and label accuracy (0.90) on the held-out test set, with a concept accuracy of 0.70. Under asymmetric filtering, EfficientNet-B7 leads across all four metrics, reaching a label F1 score of 0.82 and concept accuracy of 0.70. These results establish reproducible baselines for concept-consistent CBM evaluation on dermoscopic data.