Diagnostic Performance of Deep Learning Algorithms Applied to Three Common Diagnoses in Dermatopathology
Open accessAbstract
BACKGROUND: Artificial intelligence is advancing at an accelerated pace into clinical applications, providing opportunities for increased efficiency, improved accuracy, and cost savings through computer-aided diagnostics. Dermatopathology, with emphasis on pattern recognition, offers a unique opportunity for testing deep learning algorithms. AIMS: This study aims to determine the accuracy of deep learning algorithms to diagnose three common dermatopathology diagnoses. METHODS: Whole slide images (WSI) of previously diagnosed nodular basal cell carcinomas (BCCs), dermal nevi, and seborrheic keratoses were annotated for areas of distinct morphology. Unannotated WSIs, consisting of five distractor diagnoses of common neoplastic and inflammatory diagnoses, were included in each training set. A proprietary fully convolutional neural network was developed to train algorithms to classify test images as positive or negative relative to ground truth diagnosis. RESULTS: Artificial intelligence system accurately classified 123/124 (99.45%) BCCs (nodular), 113/114 (99.4%) dermal nevi, and 123/123 (100%) seborrheic keratoses. CONCLUSIONS: Artificial intelligence using deep learning algorithms is a potential adjunct to diagnosis and may result in improved workflow efficiencies for dermatopathologists and laboratories.
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Olsen et al. found CNNs obtained 99.0% accuracy on carefully selected image patches but only 52.3% on non-selected ones; on whole-slide images, accuracy was 92%, sensitivity 85%, and specificity 99%.
“They discovered that CNNs obtained 99.0% accuracy on carefully selected image patches while this was only 52.3% on non-selected ones. On WSI the performance was better as CNNs had an accuracy of 92%, sensitivity of 85% and specificity of 99%.”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Results (Sensitivity and specificity analysis; page unavailable) report whole-slide balanced accuracies of 99.45% for nodular BCC, 99.4% for dermal nevi, and 100% for seborrheic keratoses—not the claimed 92%. They also report 100% sensitivity and 98.9% specificity for nodular BCC. The Methods discuss image patches but do not report the claimed 99.0% versus 52.3% patch comparison. (LLM, conf=0.86)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe performance decline identified by Olsen et al. confirms the generalizability gap noted in Hart et al., suggesting this constraint is systemic among CNN-based models rather than an isolated occurrence.
“The performance decline identified by, Olsen et al. (28) confirms the generalizability gap noted in Hart et al. (22) suggesting that this constraint is systemic among CNN-based models rather than an isolated occurrence.”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Results (Sensitivity and specificity analysis; page unavailable) report 99.45%, 99.4%, and 100% balanced accuracy on the three test sets, not a performance decline. The Discussion (page unavailable) describes the train–test split as showing generalizability and performance on out-of-sample observations. It does not establish a systemic constraint among CNN models. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredThe scoping review captures how model performance reduces when datasets used are non-curated or in real-world scenarios, as seen in Hart et al. and Olsen et al.
“The scoping review also captures how model performance reduces when the datasets used are non-curated or in real-world scenarios, as seen in the works of Hart et al. (22) and Olsen et al. (28).”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Results (Sensitivity and specificity analysis; page unavailable) report 99.45% and 99.4% balanced accuracy for two algorithms and 100% correct classification for seborrheic keratosis. The Discussion (page unavailable) says the seborrheic keratosis training and test set was more rigorous, yet it had the highest yield—the opposite of reduced performance on a more challenging set. The paper does not report a separate test on non-curated datasets or in real-world deployment. (LLM, conf=0.82)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredOlsen et al. used and compared CNNs for identifying dermatopathological diseases and found 99% accuracy on curated image patches, decreasing to 52.3% on non-curated patches.
“Technically, Olsen et al. (28) used and compared CNNs for identifying dermatopathological diseases and found that it gives 99% accuracy on curated image patches, but decreases to 52.3% on non-curated patches.”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Methods (Algorithm development and training) describe CNNs used to identify dermatopathological lesions, and the Results (Sensitivity and specificity analysis) report 99.45% balanced accuracy for nodular BCC. The paper does not report a comparison of curated with non-curated image patches or a decrease to 52.3%; its reported accuracy concerns a different testing setup. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThis was especially true when circumstances displayed similar visual traits, highlighting the necessity for improved and more diverse data sets.
“This was especially true when the circumstances displayed similar visual traits, highlighting the necessity for improved and more diverse data sets.”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Discussion (page unavailable) identifies diagnoses with similar visual appearances and says future data collection should include more look-alike distractors to strengthen the algorithms. It does not show that performance problems were especially pronounced for visually similar diagnoses; the Results (page unavailable) report high accuracy, including perfect classification in the seborrheic keratosis test set. (LLM, conf=0.82)
Experimental — accuracy not yet measured
The field of inflammatory dermatopathology is largely unexplored by AI systems.
“On the other hand, the field of inflammatory dermatopathology is largely unexplored by AI systems [11,16,17].”
From Artificial Intelligence in the Histopathological Assessment of Non-Neoplastic Skin Disorders: A Narrative Review with Future Perspectives (2025) · cites this paper as [16]
The Introduction and Discussion describe AI testing for three diagnoses—nodular basal cell carcinoma, dermal nevus, and seborrheic keratosis—but do not assess how extensively AI has explored inflammatory dermatopathology. A search for inflammatory dermatopathology found an inflammatory condition used as a distractor in Methods, not a statement about the field’s research coverage. (LLM, conf=0.72)
Experimental — accuracy not yet measuredIn 94% of cases, Spitz lesions were misdiagnosed as conventional melanocytic lesions.
“The study showed that, in 94% of the cases, the Spitz lesions were misdiagnosed as conventional melanocytic lesions”
From Revolutionizing dermatopathology using AI in skin diagnostics: scoping review (2026) · cites this paper as [28]
The Results section reports classification of nodular basal cell carcinoma, dermal nevi, and seborrheic keratoses, not Spitz lesions. The Discussion mentions Spitz nevi only as possible distractors for future training. Searches for the claimed 94% Spitz-lesion misdiagnosis found no such result in our copy; page numbers were not available. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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- Authors
- Olsen, T. G., Jackson, B. H., Feeser, T. A., Kent, M. N., Moad, J. C., Krishnamurthy, S., Lunsford, D. D., & Soans, R. E.
- Affiliations
- Wright State University (US)
- Corresponding author
- Kent, Michael N.
- ORCID
- Soans, Rajath E.
- Venue
- Journal of Pathology Informatics
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 9
- Issue
- 1
- Pages
- 32
- ISSN
- 2153-3539 (ISSN-L)
- PMC
- PMC6166480
- OpenAlex
- W2894398812
- Cited by
- 119
- References
- 44
- Citations by year
- 2026: 9 · 2025: 18 · 2024: 14 · 2023: 13 · 2022: 21 · 2021: 14 · 2020: 17 · 2019: 12 · 2018: 1
- FWCI
- 6.19
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Pathology Informatics (publishedVersion, cc-by-nc-sa)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-sa)
- PubMed Central (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Physical Sciences › Computer Science › Artificial Intelligence › AI in cancer detection
- Health Sciences › Medicine › Oncology › Cutaneous Melanoma Detection and Management
- Health Sciences › Medicine › Health Informatics › Artificial Intelligence in Healthcare and Education
- Keywords
- deep learning, dermatopathology, computer-aided diagnosis, nodular basal cell carcinoma, seborrheic keratosis, whole slide images, convolutional neural networks, diagnostic accuracy, skin lesions
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