Teledermatology has developed rapidly in recent years and is nowadays an essential tool for early diagnosis. In this work, we aim to improve existing Teledermatology processes for skin lesion diagnosis by developing a deep learning approach for risk prioritization with a dataset of retrospective data from referral requests of the Portuguese National Health System. Given the high complexity of this task, we propose a new prioritization pipeline guided and inspired by domain knowledge. We explored automatic lesion segmentation and tested different learning schemes, namely hierarchical classification and curriculum learning approaches, optionally including additional patient metadata. The final priority level prediction can then be obtained by combining predicted diagnosis and a baseline priority level accounting for explicit expert knowledge. In both the differential diagnosis and prioritization branches, lesion segmentation with 30% tolerance for contextual information was shown to improve classification when compared with a flat baseline model trained on original images; furthermore, the addition of patient information was not beneficial for most experiments. Curriculum learning delivered better results than a flat or hierarchical approach. The combination of diagnosis information and a knowledge map, created in collaboration with dermatologists, together with the priority achieved interesting results (best macro F1 of 43.93% for a validated test set), paving the way for new data-centric and knowledge-driven approaches.

With the increasing adoption of teledermatology, there is a need to improve the automatic organization of medical records, being dermatological image modality a key filter in this process. Although there has been considerable effort in the classification of medical imaging modalities, this has not been in the field of dermatology. Moreover, as various devices are used in teledermatological consultations, image acquisition conditions may differ. In this work, two models (VGG-16 and MobileNetV2) were used to classify dermatological images from the Portuguese National Health System according to their modality. Afterwards, four incremental learning strategies were applied to these models, namely naive, elastic weight consolidation, averaged gradient episodic memory, and experience replay, enabling their adaptation to new conditions while preserving previously acquired knowledge. The evaluation considered catastrophic forgetting, accuracy, and computational cost. The MobileNetV2 trained with the experience replay strategy, with 500 images in memory, achieved a global accuracy of 86.04% with only 0.0344 of forgetting, which is 6.98% less than the second-best strategy. Regarding efficiency, this strategy took 56 s per epoch longer than the baseline and required, on average, 4554 megabytes of RAM during training. Promising results were achieved, proving the effectiveness of the proposed approach.

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