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IN

DEGREE PROJECT COMPUTER ENGINEERING, FIRST CYCLE, 15 CREDITS

STOCKHOLM SWEDEN 2019,

Skin Cancer Image Classification with Pre-trained Convolutional Neural Network Architectures

MICHAELA SAHLGREN NOUR ALHUDA ALMAJNI

KTH ROYAL INSTITUTE OF TECHNOLOGY

SCHOOL OF ELECTRICAL ENGINEERING AND COMPUTER SCIENCE

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Skin Cancer Image Classification with

Pre-trained Convolutional

Neural Network Architectures

MICHAELA SAHLGREN, NOUR ALHUDA ALMAJNI

Computer Science Date: June 8, 2019

Supervisor: Pawel Herman Examiner: Örjan Ekeberg

School of Electrical Engineering and Computer Science Swedish title: Bildklassificering av hudcancer med förtränade konvolutionella neurala nätverksarkitekturer

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iii

Abstract

In this study we compare the performance of different pre-trained deep convo- lutional neural network architectures on classification of skin lesion images.

We analyse the ISIC skin cancer image dataset. Our results indicate that the ar- chitectures analyzed achieve similar performance, with each algorithm reach- ing a mean five-fold cross-validation ROC AUC value between 0.82 and 0.89.

The VGG-11 architecture achieved highest performance, with a mean ROC AUC value of 0.89, despite the fact that it performs considerably worse than some of other architectures on the ILSVRC task. Overall, our results suggest that the choice of architecture may not be as crucial on skin-cancer classifica- tion compared with the ImageNet classification problem.

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iv

Sammanfattning

I denna studie jämför vi hur väl olika förtränade konvolutionella neurala nät- verksarkitekturer klassificerar bilder av potentiellt maligna födelsemärken. Det- ta med hjälp av datasetet ISIC, innehållande bilder av hudcancer. Våra resul- tat indikerar att alla arkitekturer som undersöktes gav likvärdiga resultat vad gäller hur väl de kan avgöra huruvida ett födelsemärke är malignt eller ej. Ef- ter en femfaldig korsvalidering nådde de olika arkitekturerna ett ROC AUC- medelvärde mellan 0.82 och 0.89, där nätverket Vgg-11 gjorde allra bäst ifrån sig. Detta trots att samma nätvärk är avsevärt sämre på ILSVRC. Sammanta- get indikterar våra resultat att valet av arkitektur kan vara mindre viktigt vid bildklassificering av hudcancer än vid klassificering av bilder på ImageNet.

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Contents

1 Introduction 1

1.1 Problem statement . . . 2

1.2 Scope and limitation . . . 2

1.3 Thesis outline . . . 3

2 Background 4 2.1 Image classification . . . 4

2.2 Deep convolutional neural networks . . . 5

2.3 Recent improvements to deep CNN architectures . . . 5

2.4 Related work . . . 7

3 Methods 9 3.1 Data Collection . . . 9

3.2 Removal of artefacts . . . 9

3.3 Generation of datasets for cross-validation . . . 10

3.4 Deep CNN architecture implementations . . . 10

3.5 Image preprocessing and data augmentation . . . 11

3.6 Transfer learning with deep CNN models . . . 11

3.7 Evaluation metrics . . . 12

4 Results 13 5 Discussion 17 6 Conclusions 19 6.1 Future Work . . . 19

Bibliography 21

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Chapter 1 Introduction

In 2016, 7161 people were diagnosed with skin cancer in Sweden [1], whilst in the US there are 5.4 million new cases of skin cancer every year [2]. The most dangerous skin cancer is melanoma, which is responsible for 75% of all skin cancer related deaths. Early detection of melanoma is crucial for patient survival: The five year survival of patients is 99%, compared with 14% for patients where melanoma is diagnosed in its late stage [2]. Melanomas can be accurately identified through visual inspection by a trained expert. However, most moles occurring on the skin are benign. This means that screening the population to enable early detection of melanomas is currently infeasible.

Recent research indicates that computer vision techniques may prove effective in assisting doctors with diagnosis of skin cancer, based on photograph images [2]. Currently, the most effective computer vision algorithms make use of deep convolutional neural networks (CNNs). Deep CNNs refine classical artificial neural networks with various techniques to enable higher performance on im- age analysis tasks [3, 4, 5]. Estava et al. [2] showed that deep CNNs are able to perform as well as human experts at the task of identifying skin can- cer from photographs [2]. Further work is required to understand the current performance of deep CNNs in the context of skin cancer image classification.

One problem presented by training a deep neural network from scratch is that achieving high performance may require substantial time. However, training shallow CNN architectures is also problematic when there are many classes and/or there is a variation in size, shape, and appearance between the objects,

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2 CHAPTER 1. INTRODUCTION

because the model will not have the complexity required to accommodate the wide variation in data [6]. In light of these issues, one effective approach is to perform transfer learning from a pre-trained model. Many architectures such as InceptionV3 and ResNet have been pre-trained on a large image dataset called Large Scale Visual Recognition Competition (ILSVRC) [7], and the models made publicly available [8]. These models provide a starting point for training models for different image classification tasks.

1.1 Problem statement

Improvements to deep CNN architectures are increasing the performance of image classification on commonly-used benchmarks such as ImageNet ILSVRC [9]. In this study, we investigate how much recent architectures such as Incep- tionV4 and Inception-ResNet-V2 [10] can improve image classification per- formance in the context of skin cancer diagnosis.

Specifically, we ask the question: Do recent improvements made to deep CNN architectures result in performance gains on skin lesion image classification?

By performing this analysis, we aim to improve the community’s understand- ing of the applicability of these model architectures on skin cancer image clas- sification.

1.2 Scope and limitation

This study focuses on five widely-used deep CNN model architectures: AlexNet [4], VGG-11 [11], InceptionV3 [5], InceptionV4, and Inception-Resnet-V2 [10]. These architectures were chosen based on prior evidence of their perfor- mance on ImageNet ILSVRC dataset. Inception V3, Inception V4 and Incep- tion Resnet V2 were chosen because they have been shown to perform well on the ImageNet ILSVRC classification task, based on the leader board statistics [12]. AlexNet and VGG-11 were chosen based on their inferior performance on the ImageNet ILSVRC dataset, relative to the other three models. There are many other architectures that have been applied to the ImageNet ILSVRC classification task, and researchers continue to publish new and better archi- tectures. Those architectures are not included in this study.

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CHAPTER 1. INTRODUCTION 3

The study validates the results using receiver operating characteristic (ROC) area under the curve (AUC) as the evaluation metric, and does not consider alternative performance analyses such as precision/recall curves.

When comparing model architectures, studies often perform hyperparameter search, since this enables each architecture to achieve optimal performance.

However, this was beyond the scope of the current study, and we have instead applied hyperparameter choices that are known to work well on other datasets.

This study is limited by the selection of five model architectures, the use of the ROC AUC evaluation metric, the use of the International Skin Imaging Collaboration (ISIC) dataset, pre-defined hyperparameter choices, and the use of transfer learning from the ImageNet ILSVRC dataset.

1.3 Thesis outline

The remainder of this thesis is as follows:

• Chapter 2 contains background, an explanation about the pre-trained architectures used in section 2.3, and the related work in section 2.4.

• Chapter 3 presents methodology, including an explanation of the dataset in 3.1, how the pre-trained architectures have been implemented in 3.4, and an explanation of the evaluation metrics used in 3.7.

• Chapter 4 presents results.

• Chapter 5 presents a discussion results, whilst chapter 6 provides a con- clusion and potential further work.

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Chapter 2 Background

2.1 Image classification

In the supervised image classification task, 2D images and their associated labels are used to train an algorithm to predict the label based on the image content. The ground truth label can consist of a True/False value (such as

“benign” vs “malignant”) in the case of binary image classification, or one of multiple classes in the case of multi-class classification.

Most algorithms solve this task by generating a set of features based on the image, and then generating a classification call based on those input features.

Prior to 2012, many of the state-of-the-art algorithms for supervised image classification relied upon hand-engineering to generate features from the input images. In deep learning image classification algorithms, successively richer feature maps are extracted from the image, and a final classification call is made based on those generated maps. In this approach, parameters controlling both the production of the maps and the subsequent classification are obtained by supervised learning, making manual feature map techniques unnecessary [6].

Deep learning approaches have dominated the image analysis field since the publication of AlexNet in 2012 [4].

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CHAPTER 2. BACKGROUND 5

2.2 Deep convolutional neural networks

Artificial neural networks (ANNs) are a class of machine learning methods that can be used to solve a wide variety of tasks. They consist of one or more layers of units, which each compute a weighted sum of a set of inputs.

Convolutional neural networks (CNNs) modify ANNs by replacing the stan- dard neural network unit with a convolutional unit [13].

Deep CNN models work as follows (Figure 2.1). The image data is input as three channels (Red / Green / Blue). These data are then processed using con- volutional layers, which contain trainable parameters. Each CNN layer con- tains convolutional kernels, which each produce a 2D feature map. Many such layers are stacked, and ultimately input into a final layer producing prediction probabilities. During model training, these output probabilities are compared against the provided training labels to produce a loss. The loss information is then used to update the trainable parameters using backpropagation and stochastic gradient descent.

Deep CNN models have proven effective in supervised image classification tasks, when sufficiently large training datasets are available [4]. Furthermore, it is possible to attain high accuracy on image classification on relatively small training datasets containing only thousands or even hundreds of training ex- amples, by initiating training from a model that has already been trained on a large dataset [2]. This technique is known as transfer learning. Many widely- used models such as Google’s Inception (V1/V2/V3) and Resnet have been pre-trained on a dataset called ImageNet. This dataset contains more than 14 million images that belong to more than 20,000 classes. Such pre-trained mod- els can serve as a useful starting point for performing transfer learning, and as a tool to achieve improved performance on the problem at hand.

2.3 Recent improvements to deep CNN ar- chitectures

Since the publication of AlexNet, various architectural refinements to deep CNNs have been discovered, which can enable improved performance on im-

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6 CHAPTER 2. BACKGROUND

Figure 2.1: Schematic summary of a deep CNN model architecture and train- ing. The input image is processed by a series of individual convolutional lay- ers (convlayer), each producing a set of feature maps. Final loss is computed by comparison against training labels, and this information is used to adjust model parameters during training.

age classification tasks. In this report, we consider five deep CNN architec- tures: AlexNet, VGG, InceptionV3, InceptionV4, and Inception-ResNet-V2.

The original AlexNet architecture achieved the highest accuracy in the 2012 ImageNet ILSVRC contest. This architecture made use of five convolutional layers, alternating with max-pooling layers [4]. Following this work, the VGG architecture achieved highest accuracy in the 2014 ImageNet ILSVRC contest by using smaller 3x3 convolutions, stacked to a deeper extent [11]. The later InceptionV3 network architecture [5] extended upon the Inception V1 archi- tecture [14]. These architectures make use of the inception module, which

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CHAPTER 2. BACKGROUND 7

combines several parallel convolutions and pooling operations, and reach yet higher performance on the ImageNet ILSVRC challenge. The InceptionV4 architecture makes use of a modified inception module structure, producing further performance gains [10]. Finally, Inception-ResNet-V2 [10] combines inception modules with skip-connections used in the ResNet architecture [15].

2.4 Related work

Various prior studies have investigated the performance of algorithms on skin cancer image classification. Ferris et al. applied a decision forest algorithm to a dataset of 173 dermoscopic images [16]. Mhaske and Phalke applied supervised and unsupervised methods towards detecting melanoma skin can- cer [17]. They studied a dataset of 150 images, and comparing unsupervised K-means clustering against a neural network with back propagation, and a sup- port vector machine, as supervised methods.

Several more recent studies have considered the use of deep CNN models for image classification. Esteva et al. trained a model with the Inception v3 ar- chitecture on a skin cancer image database incorporating several open-access repositories: ISIC Dermoscopic Archive, the Edinburgh Dermofit Library and data from the Stanford Hospital [18]. They considered two classification tasks.

In the first, they classified lesions into three types: benign, malignant or non- neoplastic. In the second task, they classified the lesions into nine classes, such that all diseases belonging to one class have similar a medical treatment plan [18].

In a separate study, Shihadeh et al. trained a deep CNN model to perform binary melanoma / benign skin lesion classification. They compared AlexNet architecture with an Inception v1 model, trained on the ISIC Dermoscopic database [19].

Another relevant study was carried out by Haenssle et al. The authors com- pared the diagnostic performance of a deep learning CNN for dermoscopic melanoma recognition with 58 dermatologists. They used Google Inception V4 as a pre-trained architecture and then trained it on a dataset of 100,000 im- ages. The network was trained to classify the images to a benign and melanoma.

The network achieved a specificity (the average of correctly identifing benign lesions) of 82.5% while the dermatologists achieved a specificity of 71.3% (in

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8 CHAPTER 2. BACKGROUND

level I: the dermatologists were given only dermoscopy images) and a speci- ficity of 75.7% (in level II: the dermatologists were given dermoscopy plus clinical information and images). The CNN ROC AUC was also higher than the mean ROC area of dermatologists (0.86 versus 0.79 in level I and 0.82 in level II) [20].

CNNs are also used in classifying the melanoma and benign in other types of cancer. Deniz et al. used the pre-trained architectures AlexNet and VGG16 to extract features from the histopathology images and then classify these results to benign or malignant using Support vector machine (SVM). They trained the model on a BreaKHis dataset which contains 9109 microscopic images. The highest accuracy they achieved was 91.37% ± 1.72 with fine-tuned AlexNet [21].

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Chapter 3 Methods

3.1 Data Collection

We retrieved the skin cancer classification dataset provided by the Interna- tional Skin Imaging Collaboration (ISIC), using scripts provided by a third party [22]. This dataset includes 21678 images, with associated descriptions indicating clincal status. 19616 of the images had an associated benign vs malignant status provided. We excluded the remaining images. The images had width values ranging from 576 to 6780 pixels, with total number of pixels ranging from 2.7E5 to 3.04E7. The deep CNN architectures we consider in this report typically use smaller input image resolutions, such as 299 x 299 [5]. Therefore, before running training we initially scaled all images down to a width of the observed minimum value of 576 pixels, whilst retaining aspect ratio, to improve efficiency of loading these data into memory during training and evaluation.

3.2 Removal of artefacts

Almost 10,000 of the benign lesion images contained a colored marker (Figure 3.1), whilst none of the malignant images contained these markers. To elimi- nate this artefact, we manually cropped out the marker in 5,000 of the images.

We then removed the remaining images containing the colored marker.

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10 CHAPTER 3. METHODS

Figure 3.1: Example of an image containing colored markers.

3.3 Generation of datasets for cross-validation

Following data collection and removal of artifacts, we generated datasets to support 5-fold cross-validation. Each cross-validation training dataset con- tains 13898 training items and 3474 validation items.

3.4 Deep CNN architecture implementations

We used pytorch implementations of the chosen deep CNN model architec- tures, as provided by a widely-used open source project "Pretrained models for Pytorch" [8]. For several of the architectures provided in this repository, the underlying implementations are in turn imported from torchvision [23].

We compared the performance of the models AlexNet, VGG-11, InceptionV3, InceptionV4, and InceptionResnetV2 [11, 5, 10, 4]. This choice is motivated by the prior use of InceptionV3 in the task of skin cancer image classification [18], together with the observation that InceptionV4 and InceptionResnetV2 can attain higher accuracy on the ImageNet ILSVRC 2012 classification task [10] and the [9].

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CHAPTER 3. METHODS 11

3.5 Image preprocessing and data augmen- tation

During model training, we performed image preprocessing and data augmen- tation. This includes a random crop from the input image, a random horizontal flip, and a normalization step. The normalization step used mean and standard deviation values of the red/green/blue (RGB) channels of (0.485, 0.456, 0.406) and (0.229, 0.224, 0.225) respectively.

During model evaluation, we preprocessed the images by taking a center crop of the required size, followed by the same normalization step as used in train- ing.

For all models except for InceptionV3, we specify an input image size of 224x224. For InceptionV3, we specify an input image size of 299x299.

Image preprocessing and data augmentation was implemented in pytorch, and the above preprocessing and data augmentation choices were made based on the torchvision fine-tuning tutorial [24].

3.6 Transfer learning with deep CNN models

We performed transfer learning to train the selected model architectures, start- ing from pre-trained weights derived from the ImageNet ILSVRC 2012 clas- sification task, as provided by the project "Pretrained models for Pytorch" [8].

We adapted an existing approach [24], to enable training of the selected mod- els. In this approach, the final layer of the network was replaced with a layer outputting scores for two classes (rather than the 1000 ImageNet classes), with randomly-initialized weights.

Each model was trained for 5 epochs, using the momentum optimization algo- rithm, with a learning rate of 4e 3 and a momentum value of 0.9 (Table 3.1).

We trained five versions of each model: One for each cross-validation training dataset produced. The learning rate and momentum parameters were obtained from the existing transfer learning configuration [24], whilst the number of epochs was chosen such that the validation loss had plateaued.

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12 CHAPTER 3. METHODS

Hyperparameter Value

DataAugmentation (training)

Cropping Random

Random image flipping Random

Normalization Subtract (0.485, 0.456, 0.406), divide by (0.229, 0.224, 0.225 DataPreprocessing Normalizaltion Subtract (0.485, 0.456, 0.406), divide by (0.229, 0.224, 0.225)

Image size 299x299 (InceptionV3) 224x224 (all others) Cropping(During validation) Centre

Training Learning rate 4e 3

Momentum 0.9

Epochs 5

Table 3.1: Hyperparameters used in this study

3.7 Evaluation metrics

We generated a reveiver operating characteristic (ROC) plot to visualize each model’s performance, using the validation dataset for the given cross-validation dataset. We computed the ROC data and calculated the area under curve (AUC) using sci-kit learn [25], and generated a combined ROC plot for each cross-validation dataset, using matplotlib [26].

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Chapter 4 Results

We performed feature extraction and transfer learning with five selected deep CNN models. After training the models, we ran predictions on the given cross-validation validation dataset, and generated ROC curves (Figure 4.1).

Counter to our expectations, the VGG-11 consistently performed best, achiev- ing a mean ROC AUC of 0.89 (Table 4.1), with the lowest observed cross- validation ROC AUC value (0.88) higher than the highest observed cross- validation ROC AUC for any of the other models (0.86) (Figure 4.2, Table 4.2). InceptionV4 performed worst, with a mean ROC AUC of 0.82 (Table 4.1). The remaining three models achieved similar mean ROC AUC values in the range 0.84 to 0.85 (Table 4.1). Thus, the models all achieved similar decent performance on the skin cancer classification task, performing much better than random guessing.

Inspection of a random selection of benign and malignant images suggests that the classification of images into benign vs malignant might be a some- what simple task (Figure 4.3), which could explain why a relatively shallow architecture (VGG-11) can achieve a high mean ROC AUC value.

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14 CHAPTER 4. RESULTS

Model Mean ROC AUC ImageNet Top-1 Accuracy

Alexnet 0.84842 55.88

Inceptionresnetv2 0.84298 80.4

Inceptionv3 0.85434 78.8

Inceptionv4 0.82414 80

Vgg11 0.88858 68.09

Table 4.1: Performance of the five model architectures considered on the be- nign vs malignant classification task, and the ImageNet classification task.

Mean ROC AUC values were computed using five-fold cross-validation.

Fold alexnet vgg11 inceptionresnetv2 inceptionv3 inceptionv4

0 0.83860 0.88314 0.82952 0.84945 0.82190

1 0.83873 0.87981 0.84051 0.85019 0.83127

2 0.84978 0.89499 0.84320 0.84643 0.82930

3 0.85021 0.88796 0.85374 0.86456 0.82590

4 0.86476 0.89701 0.84794 0.86105 0.81231

Table 4.2: ROC AUC values observed for each of the five cross-validation folds for the five algorithms.

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CHAPTER 4. RESULTS 15

(a) Fold 1 (b) Fold 2

(c) Fold 3 (d) Fold 4

(e) Fold 5

Figure 4.1: Cross-validation ROC plots visualising model performance on the benign vs malignant classification task. One plot is shown for each cross- validation fold (a-e).

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16 CHAPTER 4. RESULTS

Figure 4.2: Cross validation ROC AUC values observed for the five architec- tures. Five values are plotted for each architecture, corresponding to the five cross-validation folds. A small random value is added to the x-axis position of each point, to make it possible to see individual points.

Figure 4.3: Example Benign (top row) and Malignant (bottom row) images from the ISIC dataset.

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Chapter 5 Discussion

We have successfully compared the performance of five widely-used deep CNN model architectures on predicting benign vs malignant status in the ISIC skin cancer image dataset. All models perform better than random, as the AUC values are above 0.5 in every case. Overall, they are able to distinguish benign and malignant status quite effectively: The highest-performing model (VGG-11) achieved a mean cross-validation ROC AUC of 0.89, whilst the worst-performing model (InceptionV3) achieved a mean value of 0.82. This means that, given a randomly-chosen pair of benign and malignant images, our best-performing algorithm will give the malignant image a higher score 89% of the time.

The performance of the algorithms was not consistent with their performance on the ImageNet ILSVRC classification task (Table 4.1). On ImageNet data, the InceptionV4 and Inception-ResNet-V2 algorithms outperform the other algorithms, with accuracy scores of 80% and 80.4%, compared with consid- erably lower accuracy scores for VGG-11 and AlexNet (68.09% and 55.88%) [12]. Based on these results, one might expect the AlexNet and VGG-11 mod- els to perform much worse than the other models on the skin cancer classifi- cation task. Instead, we found that the VGG-11 model achieved the highest performance of the models considered, with all five models achieving fairly similar AUC scores, in the range 0.8 to 0.87.

The inconsistency between the ImageNet and the ISIC classification perfor- mances could be explained by several factors. Firstly, skin lesions are very

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18 CHAPTER 5. DISCUSSION

different in appearance to objects present in ImageNet, which consists of ev- eryday objects such as cars, dogs, and bananas. The skin lesions are usally rel- atively simple shapes, whilst an object such as a bicycle has many component shapes, arranged with very specific relative positionings and sizes. Therefore, it is possible that the algorithms are genuinely all able to perform quite well at distinguishing benign from malignant lesions, and that architectural features useful for higher performance on ImageNet (such as more convoluational lay- ers) are less important in this context. Instead, any deep CNN architecture might be able to detect textures that are a useful indicator of benign or malig- nant status.

A second potential explanation for our counterintuitive results would be the presence of a bug or error in the training and analysis procedure. A follow-up experiment could be used to eliminate this possibility. In this experiment, we would repeat the training procedure, except we would re-train the final layers to predict ImageNet classes, starting from random initializations. Using this approach, we would expect to observe very similar performances for the five networks compared to their original ImageNet performances. If this was the case, it would provide evidence that our training and evaluation procedure is working correctly and that the model archicture implementations are correct.

A third explanation for inconsistency between ImageNet and ISIC would be a data artefact of some kind, which would limit the reliability of this analysis.

We attempted to eliminate any problematic effect introduced by the colored markers. However, similar problematic correlations could exist in the ISIC dataset, which we have not detected yet. Interestingly, Estava et al. [2] do not mention removal of the colored markers in their analysis. We suspect that such data processing is key to obtaining reliable conclusions in relation to skin can- cer classification. Overall, our experience with the ISIC dataset suggests that cleaned and improved datasets could be very useful in enabling investigation of skin cancer classification algorithms.

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Chapter 6

Conclusions

Our results suggest that the choice of deep CNN architecture is not as crucial as one may initially expect based on performance of other image classification tasks. In relation to our research question, "Do recent improvements made to deep CNN architectures result in performance gains on skin lesion image classification?", our analysis suggests this is not necessarily the case. The architectural performance gains observed on the ILSVRC classification task do not appear to result in corresponding performance gains on skin lesion image classification.

Overall, deep CNN models appear to perform reasonably well at skin cancer image classification, and are a promising method for aiding medical profes- sionals in the cancer field.

6.1 Future Work

Our study investigates the impact of deep CNN model architecture in skin can- cer classification. We have not investigated other hyperparameters, such as learning rate. Appropriate hyperparameter choices are known to be very im- portant for achieving good performance on supervised learning with a deep CNN model. A follow-up investigation would explore the hyperparameter choices. This would make use of the validation dataset, which was not used in the current study. In addition, a follow-up study would likely experiment

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20 CHAPTER 6. CONCLUSIONS

with full fine-tuning of all network layers, rather than only performing feature extraction and transfer learning. However, these analyses are beyond the scope of our current work.

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