# Cascade Classification of Dermoscopic Images of Skin Neoplasms with Controllable Sensitivity and External Clinical Validation

arXiv: https://arxiv.org/abs/2606.13135 · HTML: https://mlsanity.com/paper/2606.13135/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 8 of its 17 references that are in the map.
- First posted on arXiv 11 Jun 2026.

## Builds on (most cited first, 8 of 8)

- [An Image is Worth 16x16 Words: Transformers for Image Recognition at Scale](https://mlsanity.com/paper/2010.11929/) (2020)
- [Swin Transformer: Hierarchical Vision Transformer using Shifted Windows](https://mlsanity.com/paper/2103.14030/) (2021)
- [EfficientNetV2: Smaller Models and Faster Training](https://mlsanity.com/paper/2104.00298/) (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)
- [A Patient-Centric Dataset of Images and Metadata for Identifying Melanomas Using Clinical Context](https://mlsanity.com/paper/2008.07360/) (2020)
- [Disparities in Dermatology AI: Assessments Using Diverse Clinical Images](https://mlsanity.com/paper/2111.08006/) (2021)
- [An introduction to domain adaptation and transfer learning](https://mlsanity.com/paper/1812.11806/) (2018)
- [Methodology for Creating a Clinically Verified Dermoscopic Image Dataset](https://mlsanity.com/paper/2605.25168/) (2026)

## Abstract (arXiv)

Purpose. To compare deep learning architectures and classification schemes for dermoscopic images of skin neoplasms and assess their generalization on transfer from open international datasets to independent clinical datasets of Russian practice. Methods. Four architectures (ViT-B/16, Swin-S, ConvNeXt-S, EfficientNetV2-S) were compared in three schemes: binary (malignant/benign), single-stage four-class (benign, MEL, SCC, BCC), and a two-stage cascade (binary triage, then three-class differentiation MEL/SCC/BCC). All models used ImageNet-pretrained weights and a single augmentation protocol on aggregated open ISIC Archive data, and were evaluated on an internal held-out sample and two clinical datasets (Melanoscope AI mobile system; Sechenov University). Results. Internally the binary stage attains ROC-AUC 0.952-0.966; on Sechenov University it drops to 0.797-0.893, sensitivity to 0.53-0.67, and ECE rises from 0.02 to 0.27-0.39 with underestimation of malignancy, quantifying a generalization gap in ranking and calibration. Paired tests confirm one inter-architecture result on clinical data: the deficit of ViT-B/16 at the binary stage (p<0.05); at the differentiation stage no architecture has a proven advantage. The cascade raises macro F1 over single-stage four-class classification for most architectures, but significantly only for ViT-B/16, by recovering malignant lesions assigned to the dominant benign class. On ISIC MILK10k, direct 11-class classification yields mean-class sensitivity 0.525. Conclusion. A tunable triage threshold gives sensitivity control not attainable in standard single-stage (argmax) classification and better reproduces clinical differential-diagnosis logic. The persistent generalization gap mandates external clinical validation and recalibration before deployment.