Skin lesion segmentation has achieved notable progress in recent years; however, accurate delineation remains challenging due to complex backgrounds, ambiguous boundaries, and low lesion-to-skin contrast. To address these issues, we propose the lesion-aware triple-path feature fusion network (LTPNet), an end-to-end framework that progressively processes features through extraction, refinement, and aggregation stages. In the extraction stage, we incorporate a general foreground–background attention to suppress background interference and accelerate model convergence. In the refinement stage, we introduce an attentive spatial modulator (ASM) to jointly exploit local structural cues and global semantic context for precise spatial modulation. We further develop a lesion-aware lite-gate attention (LALGA) module that performs local spatial feature modulation and global channel recalibration tailored to lesion characteristics. In the aggregation stage, we propose a triple-path feature fusion (TPFF) module that explicitly models feature relationships across scales via three complementary pathways: a common path (CP) for semantic consistency, a saliency path (SP) for highlighting co-activated regions, and a difference path (DP) for accentuating structural discrepancies. Extensive experiments on in-domain and cross-domain datasets show that LTPNet achieves superior segmentation accuracy with reasonable inference efficiency and model complexity, demonstrating its potential for efficient and reliable clinical decision support.

Deep learning methods based on convolutional neural networks (CNNs) and Mamba have advanced medical image segmentation, yet two challenges remain: (1) trade-off in feature extraction, where CNNs capture local details but miss global context, and Mamba captures global dependencies but overlooks fine structures, and (2) limited feature aggregation, as existing methods insufficiently integrate inter-layer common information and delta details, hindering robustness to subtle structures. To address these issues, we propose a hybrid cascade and dual-path adaptive aggregation network (HCDAA-Net). For feature extraction, we design a hybrid cascade structure (HCS) that alternately applies ResNet and Mamba modules, achieving a spatial balance between local detail preservation and global semantic modeling. We further employ a general channel-crossing attention mechanism to enhance feature expression, complementing this spatial modeling and accelerating convergence. For feature aggregation, we first propose correlation-aware aggregation (CAA) to model correlations among features of the same lesions or anatomical structures. Second, we develop a dual-path adaptive feature aggregation (DAFA) module: the common path captures stable cross-layer semantics and suppresses redundancy, while the delta path emphasizes subtle differences to strengthen the model’s sensitivity to fine details. Finally, we introduce a residual-gated visual state space module (RG-VSS), which dynamically modulates information flow via a convolution-enhanced residual gating mechanism to refine fused representations. Experiments on diverse datasets demonstrate that our HCDAA-Net outperforms some state-of-the-art (SOTA) approaches.