Recently, there has been great interest in developing Artificial Intelligence (AI) enabled computer-aided diagnostics solutions for the diagnosis of skin cancer. With the increasing incidence of skin cancers, low awareness among a growing population, and a lack of adequate clinical expertise and services, there is an immediate need for AI systems to assist clinicians in this domain. A large number of skin lesion datasets are available publicly, and researchers have developed AI solutions, particularly deep learning algorithms, to distinguish malignant skin lesions from benign lesions in different image modalities such as dermoscopic, clinical, and histopathology images. Despite the various claims of AI systems achieving higher accuracy than dermatologists in the classification of different skin lesions, these AI systems are still in the very early stages of clinical application in terms of being ready to aid clinicians in the diagnosis of skin cancers. In this review, we discuss advancements in the digital image-based AI solutions for the diagnosis of skin cancer, along with some challenges and future opportunities to improve these AI systems to support dermatologists and enhance their ability to diagnose skin cancer.

Early detection of skin cancer, particularly melanoma, is crucial to enable advanced treatment. Due to the rapid growth in the number of skin cancers, there is a growing need of computerised analysis for skin lesions. The state-of-the-art public available datasets for skin lesions are often accompanied with a very limited amount of segmentation ground truth labeling. Also, the available segmentation datasets consist of noisy expert annotations reflecting the fact that precise annotations to represent the boundary of skin lesions are laborious and expensive. The lesion boundary segmentation is vital to locate the lesion accurately in dermoscopic images and lesion diagnosis of different skin lesion types. In this work, we propose the fully automated deep learning ensemble methods to achieve high sensitivity and high specificity in lesion boundary segmentation. We trained the ensemble methods based on Mask RCNN and DeeplabV3+ methods on ISIC-2017 segmentation training set and evaluate the performance of the ensemble networks on ISIC-2017 testing set and PH2 dataset. Our results showed that the proposed ensemble methods segmented the skin lesions with Sensitivity of 89.93% and Specificity of 97.94% for the ISIC-2017 testing set. The proposed ensemble method Ensemble-A outperformed FrCN, FCNs, U-Net, and SegNet in Sensitivity by 4.4%, 8.8%, 22.7%, and 9.8% respectively. Furthermore, the proposed ensemble method Ensemble-S achieved a specificity score of 97.98% for clinically benign cases, 97.30% for the melanoma cases, and 98.58% for the seborrhoeic keratosis cases on ISIC-2017 testing set, exhibiting better performance than FrCN, FCNs, U-Net, and SegNet.

Globally, in 2016, 1 out of 11 adults suffered from diabetes mellitus. Diabetic foot ulcers (DFU) are a major complication of this disease, which if not managed properly can lead to amputation. Current clinical approaches to DFU treatment rely on patient and clinician vigilance, which has significant limitations, such as the high cost involved in the diagnosis, treatment, and lengthy care of the DFU. We collected an extensive dataset of foot images, which contain DFU from different patients. In this DFU classification problem, we assessed the two classes as normal skin (healthy skin) and abnormal skin (DFU). In this paper, we have proposed the use of machine learning algorithms to extract the features for DFU and healthy skin patches to understand the differences in the computer vision perspective. This experiment is performed to evaluate the skin conditions of both classes that are at high risk of misclassification by computer vision algorithms. Furthermore, we used convolutional neural networks for the first time in this binary classification. We have proposed a novel convolutional neural network architecture, DFUNet, with better feature extraction to identify the feature differences between healthy skin and the DFU. Using 10-fold cross validation, DFUNet achieved an AUC score of 0.961. This outperformed both the traditional machine learning and deep learning classifiers we have tested. Here, we present the development of a novel and highly sensitive DFUNet for objectively detecting the presence of DFUs. This novel approach has the potential to deliver a paradigm shift in diabetic foot care among diabetic patients, which represent a cost-effective, remote, and convenient healthcare solution.

Recognition and analysis of Diabetic Foot Ulcers (DFU) using computerized methods is an emerging research area with the evolution of image-based machine learning algorithms. Existing research using visual computerized methods mainly focuses on recognition, detection, and segmentation of the visual appearance of the DFU as well as tissue classification. According to DFU medical classification systems, the presence of infection (bacteria in the wound) and ischaemia (inadequate blood supply) has important clinical implications for DFU assessment, which are used to predict the risk of amputation. In this work, we propose a new dataset and computer vision techniques to identify the presence of infection and ischaemia in DFU. This is the first time a DFU dataset with ground truth labels of ischaemia and infection cases is introduced for research purposes. For the handcrafted machine learning approach, we propose a new feature descriptor, namely the Superpixel Colour Descriptor. Then we use the Ensemble Convolutional Neural Network (CNN) model for more effective recognition of ischaemia and infection. We propose to use a natural data-augmentation method, which identifies the region of interest on foot images and focuses on finding the salient features existing in this area. Finally, we evaluate the performance of our proposed techniques on binary classification, i.e. ischaemia versus non-ischaemia and infection versus non-infection. Overall, our method performed better in the classification of ischaemia than infection. We found that our proposed Ensemble CNN deep learning algorithms performed better for both classification tasks as compared to handcrafted machine learning algorithms, with 90% accuracy in ischaemia classification and 73% in infection classification.

Current practice for Diabetic Foot Ulcers (DFU) screening involves detection and localization by podiatrists. Existing automated solutions either focus on segmentation or classification. In this work, we design deep learning methods for real-time DFU localization. To produce a robust deep learning model, we collected an extensive database of 1775 images of DFU. Two medical experts produced the ground truths of this dataset by outlining the region of interest of DFU with an annotator software. Using 5-fold cross-validation, overall, Faster R-CNN with InceptionV2 model using two-tier transfer learning achieved a mean average precision of 91.8%, the speed of 48 ms for inferencing a single image and with a model size of 57.2 MB. To demonstrate the robustness and practicality of our solution to real-time prediction, we evaluated the performance of the models on a NVIDIA Jetson TX2 and a smartphone app. This work demonstrates the capability of deep learning in real-time localization of DFU, which can be further improved with a more extensive dataset.

Diabetic Foot Ulcer (DFU) is a major complication of Diabetes, which if not managed properly can lead to amputation. DFU can appear anywhere on the foot and can vary in size, colour, and contrast depending on various pathologies. Current clinical approaches to DFU treatment rely on patients and clinician vigilance, which has significant limitations such as the high cost involved in the diagnosis, treatment and lengthy care of the DFU. We introduce a dataset of 705 foot images. We provide the ground truth of ulcer region and the surrounding skin that is an important indicator for clinicians to assess the progress of ulcer. Then, we propose a two-tier transfer learning from bigger datasets to train the Fully Convolutional Networks (FCNs) to automatically segment the ulcer and surrounding skin. Using 5fold cross-validation, the proposed two-tier transfer learning FCN Models achieve a Dice Similarity Coefficient of 0.794 (±0.104) for ulcer region, 0.851 (±0.148) for surrounding skin region, and 0.899 (±0.072) for the combination of both regions. This demonstrates the potential of FCNs in DFU segmentation, which can be further improved with a larger dataset.