Group Synopsis
Group Synopsis
on
Bachelor of Technology in
Submitted by
Assistant Professor
November, 2024
CERTIFICATE
This is to certify that the project entitled “AI-Based Skin Cancer Detection” submitted by
Priyanshu Chaurasiya (2100540100126), Janhvi Pandey (2100540100084), Faraz Ahmad
Siddiqui (2100540100069), Hari Om Chaurasiya (2100540100075), Pratyush Sonwani
(2100540100121) to Babu Banarasi Das Institute of Technology & Management, Lucknow, in
partial fulfillment for the award of the degree of B. Tech in Computer Science and Engineering
is a Bonafide record of project work carried out by him/her under my/our supervision. The
contents of this report, in full or in parts, have not been submitted to any other Institution or
University for the award of any degree.
Place: Lucknow
( ii )
DECLARATION
We declare that this project report titled AI-Based Skin Cancer Detection submitted in
partial fulfillment of the degree of B. Tech in Computer Science and Engineering is a record
of original work carried out by me under the supervision of Mr. Sandeep Kummar Mishra, and
has not formed the basis for the award of any other degree or diploma, in this or any other
Institution or University. In keeping with the ethical practice of reporting scientific information,
due acknowledgments have been made wherever the findings of others have been cited.
( iii )
ACKNOWLEDGMENT
It gives us a great sense of pleasure to present the report of the B. Tech Project undertaken
during B. Tech. Final Year. We owe a special debt of gratitude to Mr. Sandeep Kumar Mishra
Assistant Professor and Dr. Anurag Tiwari (Head, Department of Computer Science and
Engineering) at Babu Banarasi Das Institute of Technology and Management, Lucknow for their
constant support and guidance throughout the course of our work. Their sincerity, thoroughness,
and perseverance have been a constant source of inspiration for us. It is only their cognizant
efforts that our endeavors have seen the light of the day. We also do not like to miss the
opportunity to acknowledge the contribution of all faculty members of the department for their
kind assistance and cooperation during the development of our project. Last but not least, we
acknowledge our family and friends for their contribution to the completion of the project.
( iv )
LIST OF TABLES
(v)
LIST OF FIGURES
( vi )
TABLE OF CONTENTS
1. Introduction 1-4
2. Literature Review 5 - 16
2.1 Literature Review 5 - 11
2.2 Comparative Study (of different papers by using table) 12 - 16
3. Research Gap 17
4. Proposed Work 18 - 20
4.1 Problem Statement 18
4.2 Proposed Approach 18 - 20
References 23 - 24
( vii )
ABSTRACT
Skin cancer, one of the most prevalent types of cancer globally, often goes undetected until
advanced stages due to limited access to early diagnostic tools. This project aims to create a user-
friendly, AI-powered platform for early skin cancer detection, leveraging advancements in
machine learning and deep learning technologies. The platform allows users to upload images of
suspected skin lesions, which are analyzed using a convolutional neural network (CNN) to
classify them as cancerous or non-cancerous with high accuracy.
The development process integrates the MERN stack for robust and interactive front-end
and back-end support, ensuring a seamless user experience. For model training, the system
employs publicly available datasets such as ISIC 2023, incorporating diverse and clinically
validated skin lesion images. To enhance model performance, techniques like data augmentation
and hyperparameter tuning are implemented, addressing challenges such as imbalanced datasets
and variability in image quality.
The ultimate goal is to democratize early skin cancer detection, empower individuals to
seek timely medical intervention and reduce the burden on healthcare systems. By combining
cutting-edge AI methodologies with a focus on accessibility and accuracy, this project aspires to
make a significant impact in the fight against skin cancer
( viii )
1. INTRODUCTION
Skin cancer is one of the most prevalent forms of cancer worldwide, and early detection
plays a critical role in increasing survival rates and improving treatment outcomes. However,
access to dermatologists and diagnostic tools remains a challenge, especially in remote or
underprivileged areas. To address this gap, we propose the development of an innovative web-
based platform that utilizes cutting-edge technologies to enable early detection of skin cancer.
This platform leverages the power of deep learning and modern web development frameworks to
provide users with a seamless, accessible, and accurate diagnostic tool.
The platform is designed to allow users to upload multiple images of skin areas where
abnormalities are suspected. These images are then analyzed using a pre-trained Convolutional
Neural Network (CNN), a deep learning model highly effective in image classification tasks. The
model has been trained on a robust dataset to detect various types of skin cancer, ensuring reliable
and accurate predictions. Upon analysis, the system provides results indicating the likelihood of
skin cancer, empowering users to take timely medical advice if necessary.
The user interface (UI) is built using [Link], ensuring a dynamic, responsive, and user-
friendly experience. React Bootstrap and styled components are utilized for styling and design
consistency, enhancing usability and accessibility.
[Link] and [Link] form the core of the backend, providing a scalable and efficient
API architecture. The backend manages user requests, processes uploaded images and interacts
with the ML model.
1.1.3 Database
(1)
MongoDB is used to store user data securely, including image metadata and results.
1.1.5 Deployment
The entire platform will be deployed on cloud services to ensure scalability, availability,
and fast processing.
The user uploads 4–5 images of the skin area they suspect might be cancerous.
The CNN model analyzes the images, classifying them into categories such as malignant,
benign, or non-cancerous. Results are displayed with confidence scores and suggestions for
further medical consultation.
(2)
1.2.4 Feedback Loop
Users have the option to provide feedback on the accuracy of the predictions, enabling
future improvements to the model.
The platform's CNN model is trained on datasets like ISIC Archive and HAM10000,
which are open-source and widely used in the dermatology and machine-learning communities.
These datasets contain thousands of high-resolution, expertly labeled images of various skin
lesions, making them ideal for training and validation. Augmentation techniques such as rotation,
flipping, and zooming are applied to increase data diversity and enhance model performance.
1.4.1 Accessibility
By providing a web-based platform, this tool makes skin cancer detection available to
anyone with an internet connection, reducing dependency on physical diagnostics.
(3)
1.4.2 Affordability
The open-source nature of the datasets and technologies ensures that the solution remains
cost-effective.
1.4.3 Accuracy
The use of deep learning techniques ensures high accuracy in predictions, minimizing false
positives and negatives.
1.4.4 Scalability
With cloud-based deployment, the platform can handle a large number of users without
performance degradation.
(4)
2. LITERATURE REVIEW
Patel et al. (2024) explored unified deep convolutional networks for skin cancer recognition,
developing a single pipeline for lesion segmentation and classification. They incorporated
advanced preprocessing methods, including histogram equalization, to enhance image quality.
The unified model demonstrated high performance on multi-class datasets, reducing the need for
separate segmentation algorithms. The study underscored the potential of integrated solutions in
streamlining clinical workflows.
Nguyen et al. (2024) explored multi-modal data fusion for skin cancer diagnosis, integrating
dermoscopic images with patient metadata. By combining visual and contextual information, their
model significantly improved diagnostic accuracy. Nguyen et al. noted the challenges of
integrating heterogeneous data sources but stressed the potential for holistic diagnostic systems
that consider both visual and clinical features.
Singh et al. (2024) explored the use of attention-based mechanisms in deep-learning models for
skin cancer diagnosis. Their proposed architecture integrated a transformer-based model with a
traditional CNN to capture global and local features effectively. This hybrid approach improved
lesion classification accuracy, particularly for complex and ambiguous cases. The authors
advocated for expanding the dataset diversity to improve the model’s generalizability across
populations.
Ghosh et al. (2024) presented an advanced transfer learning framework using pre-trained Vision
Transformers (ViTs) for skin cancer diagnosis. Their approach leveraged the powerful feature
extraction capabilities of ViTs, achieving high performance even with limited training d ata.
Ghosh et al. advocated for the adoption of transformer-based models in medical imaging, citing
their superior scalability and accuracy.
Pereira et al. (2024) explored the use of reinforcement learning to optimize feature selection for
skin cancer detection. Their methodology involved training an agent to select the most relevant
features dynamically, improving model interpretability and performance. Pereira et al. validated
their approach on benchmark datasets, demonstrating its effectiveness in enhancing diagnostic
accuracy.
(5)
Mehta et al. (2024) presented a skin cancer detection pipeline integrating image preprocessing,
segmentation, and classification. They emphasized the importance of accurate lesion
segmentation for downstream tasks and introduced a novel segmentation algorithm based on U-
Net architecture. Mehta et al. achieved significant improvements in classification accuracy,
particularly for challenging cases involving overlapping lesions.
Kumar et al. (2024) proposed a framework for real-time skin cancer detection using edge AI.
Their approach involved deploying optimized deep learning models on mobile and edge devices,
ensuring accessibility in remote areas. Kumar et al. conducted extensive testing on real-world
hardware, showcasing the feasibility of their solution. They emphasized the importance of
energy-efficient algorithms for sustainable AI deployment.
Omar et al. (2023) developed a federated learning-based framework for collaborative skin
cancer diagnosis, enabling data sharing without compromising privacy. Their model aggregated
updates from multiple hospitals, creating a robust global model. Omar et al. demonstrated that
federated learning could achieve comparable accuracy to centralized approaches while preserving
patient data privacy.
Bose et al. (2023) investigated the use of attention mechanisms in convolutional networks for
skin cancer detection. Their model employed self-attention layers to focus on critical regions of
dermoscopic images, achieving improved sensitivity and specificity. Bose et al. emphasized the
importance of explainability in medical AI, demonstrating how attention maps could provide
insights into model decision-making.
Gupta et al. (2023) introduced a novel approach that combined image super-resolution
techniques with CNNs to improve the accuracy of skin cancer detection. Their methodology
focused on enhancing low-resolution dermoscopic images using deep learning-based super-
resolution algorithms before feeding them into the classification model. The enhanced image
quality significantly improved the CNN's ability to extract meaningful features, resulting in higher
classification accuracy. This study demonstrated the potential of combining preprocessing
innovations with deep learning to tackle challenges in medical imaging.
Mitra et al. (2023) proposed a novel approach combining image preprocessing with advanced
deep-learning models for melanoma detection. Their preprocessing pipeline included noise
(6)
reduction and edge enhancement techniques, which improved the quality of features extracted by
the CNN. The model achieved high sensitivity and specificity, making it suitable for clinical use.
Mitra et al. emphasized the need for real-time deployment capabilities to enhance early diagnosis.
Khan et al. (2023) examined the application of generative adversarial networks (GANs) for data
augmentation in skin cancer detection. They generated synthetic dermoscopic images to address
data scarcity, particularly for rare skin cancer types. The research demonstrated that GAN-
augmented datasets improved CNN performance, particularly for underrepresented classes. Khan
et al. highlighted the ethical challenges of using synthetic data in medical applications, calling for
rigorous validation processes.
Chen et al. (2023) focused on deep learning techniques for detecting skin cancer, presenting a
robust framework integrating a DenseNet architecture with attention mechanisms. Their model
aimed to enhance feature selection by prioritizing regions of interest in dermoscopic images. By
using a large-scale, publicly available dataset, they achieved superior classification accuracy,
highlighting the effectiveness of attention-based models. Their study advocated for incorporating
clinical annotations to improve model interpretability and diagnostic value further.
Ahmed et al. (2023) reviewed advancements in skin cancer detection using ensemble techniques.
Their methodology integrated multiple classifiers, such as SVM and k-Nearest Neighbors (k-NN),
with pre-trained CNN models. This hybrid approach significantly improved the robustness of
classification across diverse datasets. Ahmed et al. emphasized the importance of addressing data
imbalance and recommended synthetic oversampling techniques to augment underrepresented
classes.
Patel et al. (2023) proposed an ensemble approach to skin cancer detection, integrating CNNs
with traditional machine learning classifiers like Random Forest and Gradient Boosting. This
hybrid model leveraged the strengths of both paradigms to achieve higher accuracy and
robustness. Their research showed that ensemble methods effectively mitigated the impact of data
imbalance, which is a common issue in medical datasets. Patel et al. concluded that ensemble
models represent a promising avenue for creating more reliable and comprehensive diagnostic
systems.
Huang et al. (2023) introduced a deep learning solution leveraging multi-scale feature fusion for
(7)
detecting various skin cancer types. Their approach combined features from different
convolutional layers to enhance model robustness. The study reported high accuracy and recall
rates across several benchmark datasets. Huang et al. emphasized the potential of this
methodology for improving diagnostic precision in clinical settings.
Sharma et al. (2023) analyzed the potential of hybrid deep-learning techniques for early detection
of melanoma. Their model combined ResNet and MobileNet architectures, optimizing for both
computational efficiency and accuracy. Sharma et al. utilized a diverse dataset including images
from multiple ethnic groups, emphasizing fairness in medical AI. Their findings underscore the
importance of lightweight models for deployment in resource-constrained settings, such as rural
clinics.
Ali et al. (2023) proposed a skin cancer detection framework utilizing capsule networks for better
handling of spatial relationships in images. Unlike traditional CNNs, capsule networks preserve
hierarchical information, leading to improved classification accuracy. Ali et al. validated their
approach on ISIC datasets and highlighted its robustness against variations in lighting and image
resolution. Their study emphasizes the promise of capsule networks for medical image analysis.
Chatterjee et al. (2023) investigated the role of semi-supervised learning in skin cancer
detection, addressing the challenge of limited labeled datasets. By leveraging unlabeled data
through pseudo-labeling and consistency regularization, their approach achieved high
performance with reduced labeling requirements. Chatterjee et al. demonstrated that semi-
supervised learning could enable the development of robust diagnostic models, even in data-
scarce settings.
Zhang et al. (2023) utilized graph neural networks (GNNs) to model relationships between
pixels and regions in dermoscopic images. Their approach captured structural information often
missed by CNNs, enhancing the detection of subtle skin lesions. Zhang et al. validated their model
on multiple datasets, achieving state-of-the-art performance. The study highlights the potential of
GNNs for advanced medical imaging applications.
Zhao et al. (2023) reviewed the role of federated learning in skin cancer detection, highlighting
its ability to maintain patient data privacy while enabling collaborative model training. Their
research demonstrated that federated learning frameworks could achieve comparable
(8)
performance to centrally trained models. The study called for addressing technical challenges
such as communication overhead and model convergence issues.
Rahman et al. (2023) developed an ensemble learning approach integrating gradient boosting
and deep learning models for skin cancer classification. They demonstrated that combining
decision tree-based methods with CNNs significantly improved model accuracy, particularly for
imbalanced datasets. The study highlighted the potential of ensemble methods in creating reliable
diagnostic tools for skin cancer detection.
Sun et al. (2022) employed advanced deep-learning methodologies to tackle the challenge of skin
cancer detection. Using a Convolutional Neural Network (CNN) architecture, they focused on
improving classification accuracy by integrating data augmentation techniques, such as random
cropping and flipping, to address the issue of limited datasets. Their research demonstrated that
CNN-based models significantly outperformed traditional approaches, achieving an F1 score that
reflected their robustness in dealing with imbalanced datasets. The study emphasized that further
integration of transfer learning and domain-specific preprocessing could push the boundaries of
automated skin cancer diagnosis.
Gupta et al. (2021) proposed a robust CNN framework aimed at enhancing the accuracy of skin
cancer detection. Their architecture employed multi-scale feature extraction to analyze
dermoscopic images comprehensively. Integrating techniques such as dropout regularization and
batch normalization addressed overfitting and improved model generalization. The study
demonstrated the model's ability to achieve over 90% accuracy on a publicly available dataset,
emphasizing its potential for deployment in clinical diagnostics
Jadhav et al. (2021) reviewed the landscape of deep learning technologies applied to
dermatological imaging. They explored several CNN-based solutions and their ability to classify
skin cancers with high precision. The review underscored the importance of lesion segmentation
and its impact on improving model accuracy. Furthermore, the study advocated for the inclusion
of explainable AI techniques to build trust among clinicians and improve the adoption of AI -
based solutions in healthcare settings. Their findings suggested that future advancements in real-
time processing and mobile integration could make these technologies more accessible.
Akram et al. (2020) explored the integration of machine learning techniques for skin cancer
(9)
detection, emphasizing Support Vector Machines (SVM) and Random Forest algorithms. Their
study addressed the complexity of feature extraction and its role in distinguishing malignant and
benign skin lesions. They utilized image preprocessing methods such as resizing and
normalization to enhance input data quality. The findings demonstrated that these machine
learning models performed well on benchmark datasets, achieving accuracy rates comparable to
more computationally intensive methods. The authors noted that despite their success, scalability,
and dataset diversity remain critical challenges that require attention for real-world applications.
Mendes et al. (2020) conducted a comprehensive review of deep learning applications in skin
cancer detection and diagnosis. The authors analyzed the strengths and limitations of various
CNN architectures, including ResNet, VGGNet, and Inception, focusing on their applicability to
dermoscopic images. They highlighted the transformative potential of deep learning, which offers
high sensitivity and specificity in classifying skin lesions. Mendes et al. pointed out the challenges
posed by the lack of annotated datasets and the variability in image quality, proposing
collaborative data-sharing initiatives as a way to bridge this gap.
Singh et al. (2020) examined computer-aided diagnosis (CAD) systems for skin cancer detection,
focusing on the fusion of machine-learning techniques with advanced image processing. By
leveraging features like color histograms and texture descriptors, their CAD system achieved
competitive performance in identifying skin cancer. The study highlighted the critical role of
feature selection in improving model efficiency and reducing computational overhead. Singh et
al. concluded that while CAD systems have shown promise, their real-world applicability hinges
on improving data acquisition and incorporating clinician feedback during system development.
Sharma et al. (2020) presented a deep-learning model for multi-class classification of skin cancer
types, including melanoma, basal cell carcinoma, and squamous cell carcinoma. Wang et al.
(2020) reviewed AI-based methods for skin cancer diagnosis, analyzing a range of deep learning
techniques and their applications in image classification. They highlighted the interpretability
challenges associated with deep neural networks, proposing hybrid models that combine CNNs
with rule-based systems. Their findings underscored the need for developing transparent AI
solutions that can be trusted by healthcare professionals while maintaining high-performance
metrics.
( 10 )
Using a carefully curated dataset, their model employed transfer learning with pre-trained
networks such as DenseNet. The study achieved impressive classification results, with precision
and recall metrics surpassing previous benchmarks. Sharma et al. emphasized the need for real-
time analysis capabilities to support early diagnosis and intervention in clinical practice.
( 11 )
2.2 Comparative study( Of Different Papers by using Table)
( 12 )
7. Early Detection of K. V. Patil, P. IEEE Xplore CNN, Image 2023
Skin Cancer Using A. Singh, J. Enhancement, Early
Convolutional P. Choudhary Skin Cancer
Neural Networks Detection
and Image
Enhancement
( 13 )
Review Using Skin Cancer
Deep Learning Detection
Techniques Approaches
( 14 )
Comparative Study Cancer Detection
Using Deep Systems
Learning
( 15 )
Hybrid Deep B. Tripathi, Skin Cancer Image
Learning D. K. Sharma Classification
Approach: A Novel
Framework
( 16 )
3. Research Gap
Despite significant advancements in using machine learning (ML) and deep learning (DL)
techniques for skin cancer detection, several gaps remain in this domain. A major challenge is the
limited diversity and availability of high-quality annotated datasets. Most studies rely on
benchmark datasets like ISIC, which are not always representative of global populations.
Variations in skin tones, lesion types, and environmental factors are often underrepresented,
limiting the generalizability of proposed models. This emphasizes the need for more inclusive
datasets encompassing diverse demographic and geographic profiles to ensure the fairness and
robustness of diagnostic systems.
Another critical gap lies in the explainability of ML and DL models. While many state-of-
the-art frameworks achieve high accuracy, they often operate as "black boxes," providing limited
insights into their decision-making processes. This lack of transparency can hinder clinical
adoption, as healthcare professionals require interpretable results to validate and trust the model’s
predictions. There is a pressing need to develop techniques that balance model performance with
interpretability, such as attention mechanisms or saliency map visualizations, to bridge this gap.
Lastly, deployment challenges remain a significant hurdle. Most existing models are
resource-intensive, making them unsuitable for real-time applications on low-power devices or in
resource-constrained settings. Furthermore, while federated and edge AI approaches are
emerging, their adoption still needs to be improved due to issues like data privacy, network
latency, and hardware compatibility. Addressing these gaps would require a focus on lightweight
architectures, efficient data-sharing mechanisms, and real-world validation of the models across
diverse settings.
These challenges highlight the areas where further research and development are essential,
creating opportunities to build more robust, inclusive, and deployable solutions for skin cancer
detection.
( 17 )
4. PROPOSED WORK
The proposed work focuses on designing and implementing a skin cancer detection
platform that leverages machine learning and deep learning techniques to provide early and
accurate detection of skin cancer. The platform will cater to individuals seeking accessible,
reliable diagnostic assistance through an intuitive web-based interface. The work is divided into
several key components, detailed below:
( 18 )
differentiate between melanoma, basal cell carcinoma, squamous cell carcinoma, and benign
( 19 )
conditions. Transfer learning with pre-trained architectures such as ResNet or EfficientNet will
accelerate model development and improve accuracy with fewer training images.
( 21 )
5. CONCLUSION & FUTURE WORK
5.1 CONCLUSION
Skin cancer detection and diagnosis present critical challenges, particularly in regions
lacking adequate healthcare infrastructure. This project proposed a solution leveraging
advanced machine learning and deep learning techniques to offer an accessible, accurate,
and user-friendly diagnostic tool. Through rigorous research and leveraging state -of-the-
art methodologies like Convolutional Neural Networks (CNNs), Grad-CAM visualizations,
and transfer learning models such as ResNet or EfficientNet, the system aims to deliver
reliable predictions for various skin cancer types.
The development of the platform using the MERN stack ensures scalability and
responsiveness, providing a seamless interface for users to upload images and obtain
results. Data security and user privacy are integral components, ensuring compliance with
global standards. The proposed tool not only addresses critical gaps in the availability of
affordable diagnostic solutions but also empowers users with better awareness of their
health.
While the proposed system lays a robust foundation, several aspects need further
exploration and enhancement for broader impact and scalability:
The system’s effectiveness heavily depends on the quality and diversity of training data.
Future work will involve sourcing datasets with more inclusive representation of different skin
tones, ages, and demographics to improve model generalization.
Developing a mobile app with offline diagnostic capabilities can significantly increase
accessibility, especially in remote areas with limited internet connectivity. Lightweight
( 22 )
deployment will be crucial for this extension.
By incorporating user feedback and leveraging federated learning, the model can
continuously improve while maintaining data privacy.
Linking the platform with telemedicine services would enable seamless connection
between users and healthcare providers, ensuring timely medical intervention
The platform can be expanded to diagnose a broader range of skin conditions, such as
psoriasis, eczema, and acne, further increasing its utilit
( 23 )
6. References
1. Esteva, A., Kuprel, B., Novoa, R. A., et al. (2017). "Dermatologist-level classification of
skin cancer with deep neural networks." Nature, 542(7639), 115–118.
2. Codella, N. C., Nguyen, Q. B., Pankanti, S., et al. (2018). "Skin lesion analysis toward
melanoma detection: A challenge at the 2017 International Symposium on Biomedical Imaging."
IEEE Transactions on Medical Imaging, 36(10), 2262–2272.
3. Nasr-Esfahani, E., Samavi, S., Karimi, N., et al. (2016). "Melanoma detection by analysis
of clinical images using convolutional neural networks." Pattern Recognition Letters, 86, 87–95.
4. Haenssle, H. A., et al. (2018). "Man against machine: Diagnostic performance of a deep
learning convolutional neural network for dermoscopic melanoma recognition in comparison to
58 dermatologists." Annals of Oncology, 29(8), 1836–1842.
5. Jafari, M. H., et al. (2023). "Skin Cancer Detection Using Deep Learning Techniques: A
Comprehensive Review." Applied Sciences, 13(1), 112–132.
6. Yu, L., Chen, H., Dou, Q., et al. (2017). "Automated melanoma recognition in dermoscopy
images via very deep residual networks." IEEE Transactions on Medical Imaging, 36(4), 994–
1004.
7. Goyal, M., et al. (2023). "Deep ensemble learning for skin cancer diagnosis." Journal of
Biomedical Informatics, 148, 104-115.
8. Khan, M. A., et al. (2023). "A hybrid deep learning framework for multi-class skin lesion
classification." Expert Systems with Applications, 214, 119015.
9. Saba, T., et al. (2020). "Automated dermatological diagnosis using advanced CNN-based
ensemble techniques." Artificial Intelligence in Medicine, 104, 101843.
10. Matsunaga, K., Hamada, A., Minagawa, A., et al. (2017). "Image classification of
( 24 )
melanoma, nevus, and seborrheic keratosis by deep neural network ensemble." PLoS ONE, 12(6),
e0179923.
11. Esteva, A., et al. (2023). "Advancements in Skin Lesion Classification Using Generative
Models." Medical Image Analysis, 86, 102-135.
12. Brinker, T. J., et al. (2021). "Skin cancer detection apps: Appraisal of their performance
and clinical impact." JAMA Dermatology, 157(1), 34–40.
( 25 )