Cited by 14,362Cutaneous Melanoma Detection and ManagementAI in cancer detectionAdvanced Neural Network Applications

Dermatologist-level classification of skin cancer with deep neural networks

Open access
Esteva, Andre, Kuprel, Brett, Novoa, Roberto A., Ko, Justin, Swetter, Susan M., Blau, Helen M., Thrun, Sebastian·2017·Nature

Abstract

Skin cancer, the most common human malignancy, is primarily diagnosed visually, beginning with an initial clinical screening and followed potentially by dermoscopic analysis, a biopsy and histopathological examination. Automated classification of skin lesions using images is a challenging task owing to the fine-grained variability in the appearance of skin lesions. Deep convolutional neural networks (CNNs) show potential for general and highly variable tasks across many fine-grained object categories. Here we demonstrate classification of skin lesions using a single CNN, trained end-to-end from images directly, using only pixels and disease labels as inputs. We train a CNN using a dataset of 129,450 clinical images—two orders of magnitude larger than previous datasets—consisting of 2,032 different diseases. We test its performance against 21 board-certified dermatologists on biopsy-proven clinical images with two critical binary classification use cases: keratinocyte carcinomas versus benign seborrheic keratoses; and malignant melanomas versus benign nevi. The first case represents the identification of the most common cancers, the second represents the identification of the deadliest skin cancer. The CNN achieves performance on par with all tested experts across both tasks, demonstrating an artificial intelligence capable of classifying skin cancer with a level of competence comparable to dermatologists. Outfitted with deep neural networks, mobile devices can potentially extend the reach of dermatologists outside of the clinic. It is projected that 6.3 billion smartphone subscriptions will exist by the year 2021 (ref. 13) and can therefore potentially provide low-cost universal access to vital diagnostic care.

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Crossref · 10.1038/nature21056

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  • Esteva et al. found that a DL network has the same ability to diagnose disease as twenty-one board-certified dermatologists using 129,450 images of 2032 diseases.

    “Esteva et al. [45] found that a DL network has the same ability to diagnose the disease as twenty-one board-certified dermatologists using 129,450 images of 2032 diseases.”

    From Review of deep learning: concepts, CNN architectures, challenges, applications, future directions (2021) · cites this paper as [45]

    The Abstract reports training on 129,450 images spanning 2,032 diseases and performance comparable to 21 board-certified dermatologists. But the comparison was limited to specific image-based skin-lesion classification tasks, not diagnosis across all 2,032 diseases or in clinical practice. (LLM, conf=0.85)

    Experimental — accuracy not yet measured
  • Esteva et al. found a CNN achieved a sensitivity of 91.0% and specificity of 88.9% in detecting malignant lesions.

    “The CNN achieved a sensitivity of 91.0% and specificity of 88.9% in detecting malignant lesions”

    From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [21]

    The paper’s Abstract reports that the CNN distinguished malignant from benign skin lesions and evaluates its sensitivity and specificity. It does not report the claimed pairing of 91.0% sensitivity and 88.9% specificity; the figure discussed there gives sensitivity–specificity curves and an area under the curve over 91%, which is a different measure. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • Esteva et al. showed the model had comparable diagnostic performance to dermatologists, with sensitivity 91% and specificity 88.9%.

    “They showed that the model had comparable diagnostic performance to dermatologists, with a sensitivity of 91% and a specificity of 88.9%.”

    From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [21]

    The Methods section (“Sensitivity–specificity curves with different questions”; page unavailable) says the CNN was on par with dermatologists, supporting the performance comparison. The comparison passage reports an area under the curve over 91%, not 91% sensitivity, and the passages found do not report 88.9% specificity. (LLM, conf=0.88)

    Experimental — accuracy not yet measured
  • This classification aligns algorithm design with validation and implementation requirements and informs regulatory and ethical evaluation.

    “This classification aligns algorithm design with validation and implementation requirements and informs regulatory and ethical evaluation [5].”

    From Artificial Intelligence in Clinical Decision-Making: A Comprehensive Review of Diagnostic, Prognostic, and Therapeutic Applications, Validation Gaps, Bias, and Deployment Challenges (2026) · cites this paper as [5]

    The Methods (Taxonomy and Disease partitioning algorithm; page unavailable) describe classes designed for machine learning and clinical relevance, and the Abstract describes validation using those classes. The Abstract also discusses possible clinical deployment but says real-world validation is still needed. Our copy does not say that this classification establishes implementation requirements or informs regulatory and ethical evaluation. (LLM, conf=0.84)

    Experimental — accuracy not yet measured
  • Deep neural networks have shown high accuracy at pattern recognition from noisy, complex inputs, including automated detection of diabetic retinopathy from images, skin cancer from mobile phone cameras, and onset of health conditions from electronic medical records.

    “Deep neural networks (LeCun, Bengio, and Hinton 2015) have shown high accuracy at pattern recognition from noisy, complex inputs, including automated detection of diabetic retinopathy from images (Gulshan et al. 2016), skin cancer from mobile phone cameras (Esteva et al. 2017), and the onset of health conditions from electronic medical records (Razavian, Marcus, and Sontag 2016; Lipton et al. 2015”

    From DeepHeart: Semi-Supervised Sequence Learning for Cardiovascular Risk Prediction (2018) · cites this paper as Esteva et al. 2017

    Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 4

  1. [5]LeCun Y & Bengio Y In The Handbook of Brain Theory and Neural Networks (ed. Arbib MA) 3361. 10 (MIT Press, 1995).
  2. [18]Gutman D Skin lesion analysis toward melanoma detection. International Symposium on Biomedical Imaging (ISBI), (International Skin Imaging Collaboration (ISIC), 2016).
  3. [20]Menzies SW In Skin Cancer and UV Radiation (eds Altmeyer P, Hoffmann K & Stücker M) 1064– 1070 (Springer, 1997).
  4. [24]Ballerini L In Color Medical Image Analysis. (eds, Celebi ME & Schaefer G) 63– 86 (Springer, 2013).

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Authors
Esteva, A., Kuprel, B., Novoa, R. A., Ko, J., Swetter, S. M., Blau, H. M., & Thrun, S.
Affiliations
  • Stanford University (US)
  • Stanford Medicine (US)
  • VA Palo Alto Health Care System (US)
  • Institute for Stem Cell Biology and Regenerative Medicine (US)
Corresponding author
  • Esteva, Andre
  • Kuprel, Brett
  • Novoa, Roberto A.
  • Thrun, Sebastian
Venue
Nature
Published
2017-01-25
Volume
542
Issue
7639
Pages
115-118
ISSN
  • 0028-0836 (ISSN-L)
  • 1476-4687
OpenAlex
W2581082771
Cited by
14,362
References
26
Citations by year
2026: 1681 · 2025: 2079 · 2024: 1706 · 2023: 1544 · 2022: 1495 · 2021: 1739 · 2020: 1647 · 2019: 1324 · 2018: 862 · 2017: 266 · 2016: 1 · 2015: 2 · 2014: 3 · 2012: 1
FWCI
490.95
Type
journal article
Language
en
Update notices
erratum (2017-06-29)
Open access
Locations
  • Nature (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
Funders
  • National Institutes of Health (UL1TR001085)
  • National Institute on Aging (R01AG009521, R21AG044815, R01AG020961)
  • National Institute of Neurological Disorders and Stroke (R01NS089533)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR063963)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
  • Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
  • Physical Sciences › Computer Science › Computer Vision and Pattern Recognition › Advanced Neural Network Applications
Keywords
skin cancer classification, skin lesion images, deep convolutional neural networks, melanoma, non-melanoma skin cancer, seborrheic keratosis, benign nevi, mobile phone imaging, clinical screening, fine-grained image classification
MeSH terms
Dermatologists, Automation, Humans, Melanoma, Nevus, Photography, Skin Neoplasms, Reproducibility of Results, Keratinocytes, Neural Networks, Computer, Keratosis, Seborrheic, Cell Phone, Datasets as Topic

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