Disease Burden over Skin Tone: Decomposing the Dermatology-AI Generalization Gap

The study examines why dermatology AI models, largely trained on light‑skinned, cancer‑focused images, perform poorly when applied to diverse patient populations. By comparing a cancer‑trained baseline, two dermatology foundation models, and a general‑purpose vision model on tone‑stratified and disease‑shifted datasets, the authors find that disease‑distribution shift, rather than skin‑tone underrepresentation, is the primary cause of generalization failure. Representation analysis shows that cancer‑specialized features lack transferable structure, while dermatology‑pretrained features maintain stronger clustering, and lightweight adaptation with about ten labeled examples per category can recover most performance.

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