{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:31:05Z","timestamp":1790807465987,"version":"4.1.0"},"reference-count":28,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T00:00:00Z","timestamp":1729123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Diagnosing atypical pigmented facial lesions (aPFLs) is a challenging topic for dermatologists. Accurate diagnosis of these lesions is crucial for effective patient management, especially in dermatology, where visual assessment plays a central role. Incorrect diagnoses can result in mismanagement, delays in appropriate interventions, and potential harm. AI, however, holds the potential to enhance diagnostic accuracy and provide reliable support to clinicians. This work aimed to evaluate and compare the effectiveness of machine learning (logistic regression of lesion features and patient metadata) and deep learning (CNN analysis of images) models in dermoscopy diagnosis and the management of aPFLs. This study involved the analysis of 1197 dermoscopic images of facial lesions excised due to suspicious and histologically confirmed malignancy, classified into seven classes (lentigo maligna\u2014LM; lentigo maligna melanoma\u2014LMM; atypical nevi\u2014AN; pigmented actinic keratosis\u2014PAK; solar lentigo\u2014SL; seborrheic keratosis\u2014SK; and seborrheic lichenoid keratosis\u2014SLK). Image samples were collected through the Integrated Dermoscopy Score (iDScore) project. The statistical analysis of the dataset shows that the patients mean age was 65.5 \u00b1 14.2, and the gender was equally distributed (580 males\u201448.5%; 617 females\u201451.5%). A total of 41.7% of the sample constituted malignant lesions (LM and LMM). Meanwhile, the benign lesions were mainly PAK (19.3%), followed by SL (22.2%), AN (10.4%), SK (4.0%), and SLK (2.3%). The lesions were mainly localised in the cheek and nose areas. A stratified analysis of the assessment provided by the enrolled dermatologists was also performed, resulting in 2445 evaluations of the 1197 images (2.1 evaluations per image on average). The physicians demonstrated higher accuracy in differentiating between malignant and benign lesions (71.2%) than in distinguishing between the seven specific diagnoses across all the images (42.9%). The logistic regression model obtained a precision of 39.1%, a sensitivity of 100%, a specificity of 33.9%, and an accuracy of 53.6% on the test set, while the CNN model showed lower sensitivity (58.2%) and higher precision (47.0%), specificity (90.8%), and accuracy (59.5%) for melanoma diagnosis. This research demonstrates how AI can enhance the diagnostic accuracy in complex dermatological cases like aPFLs by integrating AI models with clinical data and evaluating different diagnostic approaches, paving the way for more precise and scalable AI applications in dermatology, showing their critical role in improving patient management and the outcomes in dermatology.<\/jats:p>","DOI":"10.3390\/bioengineering11101036","type":"journal-article","created":{"date-parts":[[2024,10,17]],"date-time":"2024-10-17T04:42:15Z","timestamp":1729140135000},"page":"1036","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Comparative Analysis of AI Models for Atypical Pigmented Facial Lesion Diagnosis"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1818-6275","authenticated-orcid":false,"given":"Alessandra","family":"Cartocci","sequence":"first","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7615-9187","authenticated-orcid":false,"given":"Alessio","family":"Luschi","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6691-4310","authenticated-orcid":false,"given":"Linda","family":"Tognetti","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4009-0659","authenticated-orcid":false,"given":"Elisa","family":"Cinotti","sequence":"additional","affiliation":[{"name":"Dermatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Farnetani","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7193-0964","authenticated-orcid":false,"given":"Aimilios","family":"Lallas","sequence":"additional","affiliation":[{"name":"First Department of Dermatology, Aristotle University, 541 24 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1326-8535","authenticated-orcid":false,"given":"John","family":"Paoli","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden"},{"name":"Department of Dermatology and Venereology, Region Vastra Gotaland, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Longo","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Modena and Reggio Emilia, 41121 Modena, Italy"},{"name":"Centro Oncologico ad Alta Tecnologia Diagnostica, Azienda Unit\u00e0 Sanitaria Locale, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elvira","family":"Moscarella","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University of Campania Luigi Vanvitelli, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danica","family":"Tiodorovic","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, Medical Faculty, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ignazio","family":"Stanganelli","sequence":"additional","affiliation":[{"name":"Skin Cancer Unit, Scientific Institute of Romagna for the Study of Cancer, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Romagnolo per lo Studio dei Tumori, 47014 Meldola, Italy"},{"name":"Department of Dermatology, University of Parma, 43121 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"Suppa","sequence":"additional","affiliation":[{"name":"Department of Dermatology, H\u00f4pital Erasme, Universit\u00e9 Libre de Bruxelles, 1050 Brussels, Belgium"},{"name":"Groupe d\u2019Imagerie Cutan\u00e9e Non-Invasive, Soci\u00e9t\u00e9 Fran\u00e7aise de Dermatologie, 75009 Paris, France"},{"name":"Department of Dermatology, Institut Jules Bordet, 1070 Brussels, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3186-2861","authenticated-orcid":false,"given":"Emi","family":"Dika","sequence":"additional","affiliation":[{"name":"Oncologic Dermatology Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Azienda Ospedaliero Universitaria Bologna, 40138 Bologna, Italy"},{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Zalaudek","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, Ospedale di Trieste, 34141 Trieste, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Antonietta","family":"Pizzichetta","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, 33081 Aviano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4479-9961","authenticated-orcid":false,"given":"Jean Luc","family":"Perrot","sequence":"additional","affiliation":[{"name":"Dermatology Unit, University Hospital of St-Etienne, 42270 Saint Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7212-573X","authenticated-orcid":false,"given":"Gabriele","family":"Cevenini","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7291-4990","authenticated-orcid":false,"given":"Ernesto","family":"Iadanza","sequence":"additional","affiliation":[{"name":"Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Rubegni","sequence":"additional","affiliation":[{"name":"Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0051-8016","authenticated-orcid":false,"given":"Harald","family":"Kittler","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0391-7810","authenticated-orcid":false,"given":"Philipp","family":"Tschandl","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Medical University of Vienna, 1090 Vienna, 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