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Multimodal large language models (MLLMs) have demonstrated promise on publicly available dermatology benchmarks. However, benchmark performance may not generalize to real-world dermatologic decision-making. To quantify this benchmark-to-bedside gap, we evaluated four open-weight MLLMs (InternVL-Chat v1.5, LLaVA-Med v1.5, SkinGPT4 and MedGemma-4B-Instruct) and one commercial MLLM (GPT-4.1) across three publicly available dermatology datasets and a retrospective multi-site hospital-based dermatology consultation cohort comprising 5,811 cases and 46,405 clinical images. Models were evaluated on two clinically relevant tasks: differential diagnosis generation and severity-based triage. Diagnostic performance was modest on public datasets and declined substantially in the real-world cohort. On public benchmarks, top-3 diagnostic accuracy reached 26.55% for the best open-weight model and 42.25% for GPT-4.1. On real-world consultation cases using images alone, top-3 diagnostic accuracy fell to 1.50%-13.35% among open-weight models and 24.65% for GPT-4.1. Incorporating clinical context improved performance across all models, increasing top-3 diagnostic accuracy up to 28.75% among open-weig

Medical vision-language models (VLMs) have shown promise as clinical assistants across various medical fields. However, specialized dermatology VLM capable of delivering professional and detailed diagnostic analysis remains underdeveloped, primarily due to less specialized text descriptions in current dermatology multimodal datasets. To address this issue, we propose MM-Skin, the first large-scale multimodal dermatology dataset that encompasses 3 imaging modalities, including clinical, dermoscopic, and pathological and nearly 10k high-quality image-text pairs collected from professional textbooks. In addition, we generate over 27k diverse, instruction-following vision question answering (VQA) samples (9 times the size of current largest dermatology VQA dataset). Leveraging public datasets and MM-Skin, we developed SkinVL, a dermatology-specific VLM designed for precise and nuanced skin disease interpretation. Comprehensive benchmark evaluations of SkinVL on VQA, supervised fine-tuning (SFT) and zero-shot classification tasks across 8 datasets, reveal its exceptional performance for skin diseases in comparison to both general and medical VLM models. The introduction of MM-Skin and S

Vision-language models (VLMs) are increasingly important in medical applications; however, their evaluation in dermatology remains limited by datasets that focus primarily on image-level classification tasks such as lesion recognition. While valuable for recognition, such datasets cannot assess the full visual understanding, language grounding, and clinical reasoning capabilities of multimodal models. Visual question answering (VQA) benchmarks are required to evaluate how models interpret dermatological images, reason over fine-grained morphology, and generate clinically meaningful descriptions. We introduce DermaBench, a clinician-annotated dermatology VQA benchmark built on the Diverse Dermatology Images (DDI) dataset. DermaBench comprises 656 clinical images from 570 unique patients spanning Fitzpatrick skin types I-VI. Using a hierarchical annotation schema with 22 main questions (single-choice, multi-choice, and open-ended), expert dermatologists annotated each image for diagnosis, anatomic site, lesion morphology, distribution, surface features, color, and image quality, together with open-ended narrative descriptions and summaries, yielding approximately 14.474 VQA-style ann

Foundation models have transformed medical image analysis by providing robust feature representations that reduce the need for large-scale task-specific training. However, current benchmarks in dermatology often reduce the complex diagnostic taxonomy to flat, binary classification tasks, such as distinguishing melanoma from benign nevi. This oversimplification obscures a model's ability to perform fine-grained differential diagnoses, which is critical for clinical workflow integration. This study evaluates the utility of embeddings derived from ten foundation models, spanning general computer vision, general medical imaging, and dermatology-specific domains, for hierarchical skin lesion classification. Using the DERM12345 dataset, which comprises 40 lesion subclasses, we calculated frozen embeddings and trained lightweight adapter models using a five-fold cross-validation. We introduce a hierarchical evaluation framework that assesses performance across four levels of clinical granularity: 40 Subclasses, 15 Main Classes, 2 and 4 Superclasses, and Binary Malignancy. Our results reveal a "granularity gap" in model capabilities: MedImageInsights achieved the strongest overall performa

Skin cancer can be life-threatening if not diagnosed early, a prevalent yet preventable disease. Globally, skin cancer is perceived among the finest prevailing cancers and millions of people are diagnosed each year. For the allotment of benign and malignant skin spots, an area of critical importance in dermatological diagnostics, the application of two prominent deep learning models, VGG16 and DenseNet201 are investigated by this paper. We evaluate these CNN architectures for their efficacy in differentiating benign from malignant skin lesions leveraging enhancements in deep learning enforced to skin cancer spotting. Our objective is to assess model accuracy and computational efficiency, offering insights into how these models could assist in early detection, diagnosis, and streamlined workflows in dermatology. We used two deep learning methods DenseNet201 and VGG16 model on a binary class dataset containing 3297 images. The best result with an accuracy of 93.79% achieved by DenseNet201. All images were resized to 224x224 by rescaling. Although both models provide excellent accuracy, there is still some room for improvement. In future using new datasets, we tend to improve our work

A major barrier to developing vision large language models (LLMs) in dermatology is the lack of large image--text pairs dataset. We introduce DermaSynth, a dataset comprising of 92,020 synthetic image--text pairs curated from 45,205 images (13,568 clinical and 35,561 dermatoscopic) for dermatology-related clinical tasks. Leveraging state-of-the-art LLMs, using Gemini 2.0, we used clinically related prompts and self-instruct method to generate diverse and rich synthetic texts. Metadata of the datasets were incorporated into the input prompts by targeting to reduce potential hallucinations. The resulting dataset builds upon open access dermatological image repositories (DERM12345, BCN20000, PAD-UFES-20, SCIN, and HIBA) that have permissive CC-BY-4.0 licenses. We also fine-tuned a preliminary Llama-3.2-11B-Vision-Instruct model, DermatoLlama 1.0, on 5,000 samples. We anticipate this dataset to support and accelerate AI research in dermatology. Data and code underlying this work are accessible at https://github.com/abdurrahimyilmaz/DermaSynth.

The emergence of vision-language models has transformed medical AI, enabling unprecedented advances in diagnostic capability and clinical applications. However, progress in dermatology has lagged behind other medical domains due to the lack of standard image-text pairs. Existing dermatological datasets are limited in both scale and depth, offering only single-label annotations across a narrow range of diseases instead of rich textual descriptions, and lacking the crucial clinical context needed for real-world applications. To address these limitations, we present Derm1M, the first large-scale vision-language dataset for dermatology, comprising 1,029,761 image-text pairs. Built from diverse educational resources and structured around a standard ontology collaboratively developed by experts, Derm1M provides comprehensive coverage for over 390 skin conditions across four hierarchical levels and 130 clinical concepts with rich contextual information such as medical history, symptoms, and skin tone. To demonstrate Derm1M potential in advancing both AI research and clinical application, we pretrained a series of CLIP-like models, collectively called DermLIP, on this dataset. The DermLIP

Deep learning models for skin disease classification require large, diverse, and well-annotated datasets. However, such resources are often limited due to privacy concerns, high annotation costs, and insufficient demographic representation. While text-to-image diffusion probabilistic models (T2I-DPMs) offer promise for medical data synthesis, their use in dermatology remains underexplored, largely due to the scarcity of rich textual descriptions in existing skin image datasets. In this work, we introduce LesionGen, a clinically informed T2I-DPM framework for dermatology image synthesis. Unlike prior methods that rely on simplistic disease labels, LesionGen is trained on structured, concept-rich dermatological captions derived from expert annotations and pseudo-generated, concept-guided reports. By fine-tuning a pretrained diffusion model on these high-quality image-caption pairs, we enable the generation of realistic and diverse skin lesion images conditioned on meaningful dermatological descriptions. Our results demonstrate that models trained solely on our synthetic dataset achieve classification accuracy comparable to those trained on real images, with notable gains in worst-cas

The rapid growth of dermatological imaging and mobile diagnostic tools calls for systems that not only demonstrate empirical performance but also provide strong theoretical guarantees. Deep learning models have shown high predictive accuracy; however, they are often criticized for lacking well, calibrated uncertainty estimates without which these models are hardly deployable in a clinical setting. To this end, we present the Conformal Bayesian Dermatological Classifier (CBDC), a well, founded framework that combines Statistical Learning Theory, Topological Data Analysis (TDA), and Bayesian Conformal Inference. CBDC offers distribution, dependent generalization bounds that reflect dermatological variability, proves a topological stability theorem that guarantees the invariance of convolutional neural network embeddings under photometric and morphological perturbations and provides finite conformal coverage guarantees for trustworthy uncertainty quantification. Through exhaustive experiments on the HAM10000, PH2, and ISIC 2020 datasets, we show that CBDC not only attains classification accuracy but also generates calibrated predictions that are interpretable from a clinical perspecti

Multimodal large language models (LLMs) are increasingly used to generate dermatology diagnostic narratives directly from images. However, reliable evaluation remains the primary bottleneck for responsible clinical deployment. We introduce a novel evaluation framework that combines DermBench, a meticulously curated benchmark, with DermEval, a robust automatic evaluator, to enable clinically meaningful, reproducible, and scalable assessment. We build DermBench, which pairs 4,000 real-world dermatology images with expert-certified diagnostic narratives and uses an LLM-based judge to score candidate narratives across clinically grounded dimensions, enabling consistent and comprehensive evaluation of multimodal models. For individual case assessment, we train DermEval, a reference-free multimodal evaluator. Given an image and a generated narrative, DermEval produces a structured critique along with an overall score and per-dimension ratings. This capability enables fine-grained, per-case analysis, which is critical for identifying model limitations and biases. Experiments on a diverse dataset of 4,500 cases demonstrate that DermBench and DermEval achieve close alignment with expert rat

The adoption of artificial intelligence in dermatology promises democratized access to healthcare, but model reliability depends on the quality and comprehensiveness of the data fueling these models. Despite rapid growth in publicly available dermatology images, the field lacks quantitative key performance indicators to measure whether new datasets expand clinical coverage or merely replicate what is already known. Here we present SkinMap, a multi-modal framework for the first comprehensive audit of the field's entire data basis. We unify the publicly available dermatology datasets into a single, queryable semantic atlas comprising more than 1.1 million images of skin conditions and quantify (i) informational novelty over time, (ii) dataset redundancy, and (iii) representation gaps across demographics and diagnoses. Despite exponential growth in dataset sizes, informational novelty across time has somewhat plateaued: Some clusters, such as common neoplasms on fair skin, are densely populated, while underrepresented skin types and many rare diseases remain unaddressed. We further identify structural gaps in coverage: Darker skin tones (Fitzpatrick V-VI) constitute only 5.8% of image

Our work introduces the DermETAS-SNA LLM Assistant that integrates Dermatology-focused Evolutionary Transformer Architecture Search with StackNet Augmented LLM. The assistant dynamically learns skin-disease classifiers and provides medically informed descriptions to facilitate clinician-patient interpretation. Contributions include: (1) Developed an ETAS framework on the SKINCON dataset to optimize a Vision Transformer (ViT) tailored for dermatological feature representation and then fine-tuned binary classifiers for each of the 23 skin disease categories in the DermNet dataset to enhance classification performance; (2) Designed a StackNet architecture that integrates multiple fine-tuned binary ViT classifiers to enhance predictive robustness and mitigate class imbalance issues; (3) Implemented a RAG pipeline, termed Diagnostic Explanation and Retrieval Model for Dermatology, which harnesses the capabilities of the Google Gemini 2.5 Pro LLM architecture to generate personalized, contextually informed diagnostic descriptions and explanations for patients, leveraging a repository of verified dermatological materials; (4) Performed extensive experimental evaluations on 23 skin disease

Skin diseases impose a substantial burden on global healthcare systems, driven by their high prevalence (affecting up to 70% of the population), complex diagnostic processes, and a critical shortage of dermatologists in resource-limited areas. While artificial intelligence(AI) tools have demonstrated promise in dermatological image analysis, current models face limitations-they often rely on large, manually labeled datasets and are built for narrow, specific tasks, making them less effective in real-world settings. To tackle these limitations, we present DermNIO, a versatile foundation model for dermatology. Trained on a curated dataset of 432,776 images from three sources (public repositories, web-sourced images, and proprietary collections), DermNIO incorporates a novel hybrid pretraining framework that augments the self-supervised learning paradigm through semi-supervised learning and knowledge-guided prototype initialization. This integrated method not only deepens the understanding of complex dermatological conditions, but also substantially enhances the generalization capability across various clinical tasks. Evaluated across 20 datasets, DermNIO consistently outperforms stat

Skin diseases, such as skin cancer, are a significant public health issue, and early diagnosis is crucial for effective treatment. Artificial intelligence (AI) algorithms have the potential to assist in triaging benign vs malignant skin lesions and improve diagnostic accuracy. However, existing AI models for skin disease diagnosis are often developed and tested on limited and biased datasets, leading to poor performance on certain skin tones. To address this problem, we propose a novel generative model, named DermDiff, that can generate diverse and representative dermoscopic image data for skin disease diagnosis. Leveraging text prompting and multimodal image-text learning, DermDiff improves the representation of underrepresented groups (patients, diseases, etc.) in highly imbalanced datasets. Our extensive experimentation showcases the effectiveness of DermDiff in terms of high fidelity and diversity. Furthermore, downstream evaluation suggests the potential of DermDiff in mitigating racial biases for dermatology diagnosis. Our code is available at https://github.com/Munia03/DermDiff

AI-based dermatology adoption remains limited by biased datasets, variable image quality, and limited validation. We introduce DermAI, a lightweight, smartphone-based application that enables real-time capture, annotation, and classification of skin lesions during routine consultations. Unlike prior dermoscopy-focused tools, DermAI performs on-device quality checks, and local model adaptation. The DermAI clinical dataset, encompasses a wide range of skin tones, ethinicity and source devices. In preliminary experiments, models trained on public datasets failed to generalize to our samples, while fine-tuning with local data improved performance. These results highlight the importance of standardized, diverse data collection aligned with healthcare needs and oriented to machine learning development.

With the widespread application of artificial intelligence (AI), particularly deep learning (DL) and vision large language models (VLLMs), in skin disease diagnosis, the need for interpretability becomes crucial. However, existing dermatology datasets are limited in their inclusion of concept-level meta-labels, and none offer rich medical descriptions in natural language. This deficiency impedes the advancement of LLM-based methods in dermatologic diagnosis. To address this gap and provide a meticulously annotated dermatology dataset with comprehensive natural language descriptions, we introduce \textbf{SkinCaRe}, a comprehensive multimodal resource that unifies \textit{SkinCAP} and \textit{SkinCoT}. \textbf{SkinCAP} comprises 4,000 images sourced from the Fitzpatrick 17k skin disease dataset and the Diverse Dermatology Images dataset, annotated by board-certified dermatologists to provide extensive medical descriptions and captions. In addition, we introduce \textbf{SkinCoT}, a curated dataset pairing 3,041 dermatologic images with clinician-verified, hierarchical chain-of-thought (CoT) diagnoses. Each diagnostic narrative is rigorously evaluated against six quality criteria and i

Recent advances in dermatological image analysis have been driven by large-scale annotated datasets; however, most existing benchmarks focus on dermatoscopic images and lack patient-authored queries and clinical context, limiting their applicability to patient-centered care. To address this gap, we introduce DermaVQA-DAS, an extension of the DermaVQA dataset that supports two complementary tasks: closed-ended question answering (QA) and dermatological lesion segmentation. Central to this work is the Dermatology Assessment Schema (DAS), a novel expert-developed framework that systematically captures clinically meaningful dermatological features in a structured and standardized form. DAS comprises 36 high-level and 27 fine-grained assessment questions, with multiple-choice options in English and Chinese. Leveraging DAS, we provide expert-annotated datasets for both closed QA and segmentation and benchmark state-of-the-art multimodal models. For segmentation, we evaluate multiple prompting strategies and show that prompt design impacts performance: the default prompt achieves the best results under Mean-of-Max and Mean-of-Mean evaluation aggregation schemes, while an augmented prompt

SkinGPT-4, a large vision-language model, leverages annotated skin disease images to augment clinical workflows in underserved communities. However, its training dataset predominantly represents lighter skin tones, limiting diagnostic accuracy for darker tones. Here, we evaluated performance biases in SkinGPT-4 across skin tones on common skin diseases, including eczema, allergic-contact dermatitis, and psoriasis using the open-sourced SCIN dataset. We leveraged the SkinGPT-4 backbone to develop finetuned models for custom skin disease classification tasks and explored bias mitigation strategies. Clinical evaluation by board-certified dermatologists on six relevant skin diseases from 300 SCIN cases assessed images for diagnostic accuracy, informativity, physician utility, and patient utility. Model fairness metrics, including demographic parity and equalized odds, were calculated across skin tones. SkinGPT-4 achieved an average demographic parity of 0.10 across Fitzpatrick types, with notable differences of 0.10-0.15 between lightest and darkest tones across evaluation metrics. Model hallucinations in artifacts and anatomy occurred at a rate of 17.8. Our customized models achieved

The growing demand for accurate and equitable AI models in digital dermatology faces a significant challenge: the lack of diverse, high-quality labeled data. In this work, we investigate the potential of domain-specific foundation models for dermatology in addressing this challenge. We utilize self-supervised learning (SSL) techniques to pre-train models on a dataset of over 240,000 dermatological images from public and private collections. Our study considers several SSL methods and compares the resulting foundation models against domain-agnostic models like those pre-trained on ImageNet and state-of-the-art models such as MONET across 12 downstream tasks. Unlike previous research, we emphasize the development of smaller models that are more suitable for resource-limited clinical settings, facilitating easier adaptation to a broad range of use cases. Results show that models pre-trained in this work not only outperform general-purpose models but also approach the performance of models 50 times larger on clinically relevant diagnostic tasks. To promote further research in this direction, we publicly release both the training code and the foundation models, which can benefit clinici