# ScaFE: Data-Efficient Scar Classification with LLM-Generated Clinical Feature Programs

arXiv: https://arxiv.org/abs/2607.28538 · HTML: https://mlsanity.com/paper/2607.28538/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 11 of its 22 references that are in the map.
- First posted on arXiv 30 Jul 2026.

## Builds on (most cited first, 11 of 11)

- [Deep Residual Learning for Image Recognition](https://mlsanity.com/paper/1512.03385/) (2015)
- [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)
- [XGBoost: A Scalable Tree Boosting System](https://mlsanity.com/paper/1603.02754/) (2016)
- [LLaVA-Med: Training a Large Language-and-Vision Assistant for Biomedicine in One Day](https://mlsanity.com/paper/2306.00890/) (2023)
- [Concept Bottleneck Models](https://mlsanity.com/paper/2007.04612/) (2020)
- [Capabilities of GPT-4 on Medical Challenge Problems](https://mlsanity.com/paper/2303.13375/) (2023)
- [A Multimodal Vision Foundation Model for Clinical Dermatology](https://mlsanity.com/paper/2410.15038/) (2024)
- [PTaRL: Prototype-based Tabular Representation Learning via Space Calibration](https://mlsanity.com/paper/2407.05364/) (2024)
- [Derm1M: A Million-scale Vision-Language Dataset Aligned with Clinical Ontology Knowledge for Dermatology](https://mlsanity.com/paper/2503.14911/) (2025)
- [Multimodal Foundation Models Exploit Text to Make Medical Image Predictions](https://mlsanity.com/paper/2311.05591/) (2023)

## Abstract (arXiv)

Classifying pathological scars from clinical photographs requires distinguishing keloids from hypertrophic scars despite limited expert-labeled data and substantial acquisition variation across hospitals. End-to-end image models remain data-dependent, whereas sending photographs to a hosted vision-language model (VLM) may conflict with local data-governance requirements and yields decisions that are difficult to reproduce and audit. We introduce ScaFE (Scar Feature Engineering), which transfers clinical knowledge from a large language model (LLM) into deterministic, executable feature programs instead of asking the model to diagnose images. A web-enabled LLM retrieves clinical evidence and synthesizes programs that measure visually assessable scar attributes. Candidate programs execute in a restricted local environment, and only aggregate validation statistics and feature-level SHAP summaries are returned for iterative repair and refinement; raw images and patient-level outputs remain local. A lightweight Random Forest then operates on the resulting structured representation. On 600 photographs from three hospitals under leave-one-site-out evaluation, ScaFE achieves 81.0% site-macro balanced accuracy, exceeding the strongest baseline, BiomedCLIP, by 10.0 percentage points. With only 10% of the development data, ScaFE retains 72.0% balanced accuracy and an 11.8-point lead. Iterative refinement also raises the executable-program rate from 66.7% to 95.0%, with verified evidence for 91.7% of the final features. These results show that LLM knowledge can support data-efficient, cross-site medical image classification through local and auditable feature programs rather than direct VLM decisions.