Automatic Segmentation and classification of Skin Lesion Images
Khaled Taouil , Nadra Ben Romdhane
Research Unit. Sciences and Technologies ofImage and Telecommunications
Higher Institute of Biotechnology, Sfax
khaledtaouil@yahoo. com, nadrabenromdhane@yahoo.fr
Abstract
The ultimate aim of this work is to provide an
automatic detection of melanoma skin lesion images
using a Computer-aided diagnosis (CAD) system.
This work presents the different steps of such a
process. We detail in this paper the segmentation
step by describing the different used methods in the
literature andpropose a hybrid approach that can be
integrated in our system.
We use three diJferent methods of automatic
segmentation based on thresholding, morphology
functions and active contours (snakes).
The malignancy signs are quantified in a set of
parameters that summarize the geometric and
photometric characteristics of the lesion. Parameters
the more robust and most discriminative have been
kept for the classification. These parameters
constitute the entry of the stage of classification by
neural network.
We evaluate our work on different cases of color
skin lesion images from digitized slides data base
selected by expert dermatologists from the hospital
"CHU de Rouen " France.
Key words
melanoma, neural network, segmentation, snake.
1. Introduction
Melanoma is an increasing form of skin cancer in
the world [1]. Theuincidenceontthe
is order of 0-12
per 100,000 in Europe, five tie moe han 50 years
ago, 18-20 per 100,000 in the USA, and 30-40 per
100,000 in Australia, where the climate and sun
exposure are especially hazardous [2].
Successful treatment of melanoma depends
directly on early diagnosis [3] [4]. The curability of
this type of skin cancer (about 70/0 ) depends on
early enough recognition and surgical treatment [5].
When melanoma is removed in its early stages, there
1 -4244-0)409-6/0)6/20(.OO( t2OO(6
is a very high likelihood that the patient will survive
[6].
The rate of accurate diagnosis is around 75°0 (true
positives) [2]. The ABCD (asymmetry, border, color,
dimension) clinical rule was introduced for assisting
the visual recognition of early melanoma [7].
Computer-aided diagnosis (CAD) systems based on
image processing were introduced since 1987 [6, 8,
9, 14]. It has been proved that such CAD systems can
improve the recognition rate of the nature of a
suspect lesion [10] [11] particularly at centers not
experienced in the field of pigmented skin lesions
[12]. However, like any image processing technique,
the results of classifiers usually depend on image
segmentation which permits the extraction of the
lesion from the surrounding skin. The edge of the
lesion is very important in the diagnosis of its nature.
An automated image segmentation method is needed
to give dermatologists a complete integrated
dermatological image analysis systems for
melanoma detection.
2. CAD systems in melanoma detection
The goal of translating knowledge of expert
physicians into a computer program has been the
object of several studies and carried out by means of
an analysis of images of skin pigmented lesions
acquired in standard color or in multispectral bands.
If reached, this goal would lead to several
advantages, such as the elimination of subjectiveness
in the diagnosis and a possible transfer outside
specialized centers of the diagnostic capability of
expert physicians [13].
Complete integrated dermatological image analysis
systems are hardly found in clinical use [5, 10].
CAD systems in melanoma detection are usually
based on image processing and data classification
methods. Five steps are generally needed. The aim of
our work is to develop an automated method in the
segmentation step.
2.1. Data acquisition
 The dermatologists use slides for lesion images
storage and visual inspection. Different image
acquisition techniques can be used. Shwindewolf
[14] has compared Color slides digitization and direct
image acquisition. In the first case, slides of
melanocytic lesions are scanned with a film scanner.
In the second case, a CCD-camera is used and the
image is directly stored on computer. He concluded
that there is no significant difference in the
recognition rates of malignant melanomas.
Dermoscopy (skin-surface microscopy or
dermatoscopy) is a non-invasive imaging technique
based on oil immersion, which renders the skin
translucent, thus allowing a better visualization of
surface and subsurface structures. Magnified
dermatoscopic images are much more detailed than
conventional macroscopic ones. Recent studies have
shown that dermatoscopic diagnosis has an accuracy
of 75% to 97% while this range is 65% to 80% for
macroscopic diagnosis [2, 15].
2.2. Pre-processing
The pre-processing step is used to filter noise in
the digitized images and to overcome different
lighten conditions. The quality of images needs also
to be improved before the segmentation step.
2.3. Segmentation
In order to quantify geometric and colorimetric
properties of a lesion, a segmentation process is used
which allows to label each pixel of the entire image
as belonging to the lesion or to the safe skin.
2.4. Quantification
In parametric classification approaches, the
description of each lesion is resumed in a vector of
features which dimension depends on the number of
extracted primitives.
2.5. Classification
To develop a classification method a data base of
malignant and benign lesions is needed. A first set of
lesions are used for training and a second set is used
for test. The nature of all used lesions has to be well
known by dermatologists.
3. The segmentation step: used methods
Image segmentation is the most critical step in the
entire process. It consists of the extraction of the
region of interest (ROI) which is the lesion. The
result of segmentation is a mask image. This mask is
the base for the computation of several shape and
color features [14].
The computer has a great difficulty in finding
lesion edge accurately. This task alone has formed
the basis of much research [16]. The difficulty of
segmentation is due to low contrast between the
lesion and the surrounding skin and irregular and
fuzzy lesion borders. Artefacts (light reflections,
shadows, overlapping hair, etc) can also give a false
segmentation result. Some works rely on the
physician to outline the suspicious area [17].
Maglogiannis et al [36] used different algorithms
for image segmentation based on thresholding, region
growing and different transforms of RGB color
components such as principal components transform
(PCT), CIELAB color space and spherical
coordinates. An expert dermatologist was then asked
to draw manually the border on the digital image.
The performance of the segmentation algorithms was
then evaluated by measuring the percentage of
common pixels between the two areas defined by the
two borders, calculated as the ratio of the intersection
divided by their union. They have also calculated the
percentage of pixels that belong to the computer-
based lesion and not to the manually determined
lesion and vice-versa. The mean of the ratio of
common pixels didn't exceed 75% with a maximum
value of 84% obtained with PCT algorithm.
Hance [18] compare six different color
segmentation algorithms (adaptive thresholding,
fuzzy-c-means, SCT/center split, PCT/median cut,
split and merge, and multiresolution segmentation.
On a test set of 66 images the lowest average error
could be achieved by adaptive thresholding (40 of 66
correct segmentations) and the PCT/median-cut
algorithm (46 good segmentations). Combining the
different methods resulted in further improvement of
correctly identified tumor boundaries (57 correct
segmentations) [10].
As we see above, several methods were used in
melanoma images segmentation. We describe below
some of them. An extensive survey of methods
dealing with macroscopic images can be found in
[15, 19].
3.1. Region approaches
most often used [10]. The pixels of an image are
grouped into regions using some similarity criteria of
some characteristic features such as intensity. The
digital photograph is made up of a number of pixels
each of a known brightness (shade of grey). Two
peaks can be seen representing the paler skin tones
and the darker lesion. Segmentation can be
performed by choosing a value of the threshold
between the peaks [16]. Five different techniques
were tested on 62 cases of image lesions [20]. The
Otsu algorithm gave the best results [21]. However,
inside the lesion some brightened values are the same
or lighter than the surrounding skin leaving holes
which have to be filled by image post-processing.
The same phenomenon can be observed with dark
small regions inside the safe skin.
Shwindewolf [14] used CIE-DIN standard color
system (Commission Internationale de l'eclairage,
Deutsches Institut fur Norming). For each pixel in the
color image (RGB), the brightness Y and the
chromacity coordinate z were calculated.
X> (0.514 0.324 0.162 R
Y = 0.265 0.670 0.065 . G
L J .024 0.123 0.853) tBJ
(1)
x y
XX+Y+Z
+Y Z + XYX + Y + Z
- skin. The image is then represented in different color
Z a vector of dimension 14. Next, image data is
X+Y+Z
(2)
Small Y-value and pixels with small z belong to the
mask. A clustering procedure was used in a two
dimensional space. An interactive and parametric
algorithm was then used with human observer who
can identify if the detected mask was wrong.
3.2. Contour approaches
When used, classical edge detectors (sobel, canny,
etc) produce a collection of edges leaving the
selection of the boundary up to the human observer.
Some of the problems noted with these methods are
due to the presence of sharp edges which are not part
of the tumor boundary. Low pass filtering to remove
skin pores, hair and other sharp edges which produce
a blurred lesion boundary. As a priori knowledge,
Goltson [22] required that the lesion be
appreciatively centered within the field of view of the
camera at the acquisition step. Then, a radial search
method stands alone as a possible approach for
boundary detection. This method proceeds from
inside the object in question out along radial lines
searching for the object boundary. Computations are
then performed only in the area of interest. This
method guarantees to find a boundary crossing along
each radial line. Discrepant points are eliminated and
confirmed points are connected.
3.3. Hybrid approaches
Scott [23] considers that artefacts must be masked
out by filling those portions of image with zeros.
These artefacts are due to noise caused by digitizing
a continuous image, imperfection in camera, lenses
and imperfections caused by lighting. Scott
segmentation method is based on a principal
components transform (PCT) and a color
compression algorithm. It is based on the statistical
properties of the image. PCT is applied to the 3D
color space RGB. Transformed image includes one
color plan with the maximum variance (large
discriminatory power). The number of colors in the
image is then reduced using an iterative median split
algorithm. A radial search is then performed along 64
radial lines extending from a point within the lesion.
De Brucq [24] used a method based on four steps.
First, an automatic thresholding algorithm produces
two approximate classes for the lesion and the safe
spaces. Thus, each pixel of the image is described by
reduced by projection on the direction of means of
the two classes. Finally, in each radial direction an
adaptive threshold is found and an edge point is
determined.
4. Snakes techniques
Snakes or active contours are curves defined
within an image domain that can move under the
influence of internal forces coming from within the
curve itself and external forces computed from the
image data [25]. Snakes were introduced by Kass et
al. [26].
There are various versions of snakes such as
directional snake[27] , gradient vector flow (GVF)
snake[28] , distance snake [29], B-Spline snake [30],
fast GVF algorithm (FGVF) [31] and force field
analysis snake (FFA snake) [32].
4.1. Parametric snake model
 Snakes are parameterized curves, v(s) =[x(s), y(s)] 5. Segmentation algorithms
s e [0,1], that move through the spatial domain of an We use hybrid skin lesion border determination
image to minimize the functional energy algorithms for dermatological images that
[25],[33],[34]: incorporate the advantages of both morphology
functions and snakes. A Matlab implementation for
1 snake algorithm was obtained from [35] and adapted
Esnake = JEint(v (s)) + Eext (v (s))
0
ds to this work.
We have compared three methods of segmentation
(3) using thresholding based on Otsu method,
thresholding and snakes (figure 1), and morphology
Eit (v (s)) = v (s)| + f3 v" (s)|
Vc functions and snakes (figure 2).
(4) 5.1. Thresholding method [20]

Eext (x, y) - VI(x, y) 12 We apply a threshold for the original image, based
(5) on Otsu method [21]. For the result image, we use a
where: morphological opening, and then we retain the
* v(s) is a set of coordinates to form a snake largest element representing the masque that will be
contour. applied to the original image of the skin lesion.
v'(s) and v"(s) denote the first and second
derivatives of v(s) with respect to s . 5.2. Thresholding and snakes method [34]:
* a and : are weighting parameters that control
respectively the snake's tension and rigidity. For the pre-processing step, we apply a threshold
VI(xsy)tis gradientiof
the r
* VI(x,Y) is the gradient of grey-level image
image for the original image based on Otsu method, we use
a morphological opening for the result image, and
I. then we retain the largest element which represents
the skin lesion region.
A snake that minimizes Esnake must satisfy the After pre-processing, we initialize the snake using
Euler equation the approximate contour of safe skin mask. The
a v"(s)- v""(s)-"s ext = 0, snake moves then closer to the real skin lesion
border.
(6)
This can be viewed as a force balance equation
Fint + Fext = 0 (7) 5.3. Morphology functions and snakes method
Where
Fint =Lclv"(s)-:v""(s) For the of pre-processing step, wefunctions
use the
av
(s) - P v" (s) combination different morphology to
and Fext -VE ext overcome noise effects which prevent the snake from
converging to the real skin lesion boundary during
The internal force Fint discourages stretching and the deformation process.
bending while the external potential force Fext pulls We apply, at first, the top-hat and bottom-hat
the snake toward the desired image edges. transforms to maximize the contrast of the lesion.
To find a solution to (4), the snake v(s) is made The top-hat transform is the difference between the
dynamic by adding the parameter of time t to the original image and its opening, (the collection of
equation of the curve that becomes: foreground parts of the image using a disc structuring
element). The bottom-hat transform is the difference
v(s, t) = V"(s t)f-Pv""(s t)-VE est between the closing of the original image (the
collection of background parts using a disc
(8) structuring element) and the original image. To
indicating how the snake must be modified at the maximize the contrast between the objects and the
instant t+1 according to its position at the instant t. gaps we add the top-hat image to the original image,
When v(s,t) stabilizes, we achieve a solution of (6). and then we subtract the bottom-hat image from the
result. Then, we let only the intensity valleys deeper
than a threshold. We remove small objects by
applying a morphological opening while preserving
the shape and size of the lesion. Approximate skin
lesion region is finally obtained after filling holes of
the result image, labeling and retaining the largest
element.
After pre-processing and initialization of the snake
using the approximate contour of safe skin mask as in
(5.3), the curve moves closer to the real skin lesion
border.
6. Classification by neural network
After having summarized the more robust and
most discriminative parameters representing the
malignancy signs contained in the different images of
our database in vectors of 14 parameters we use
neural network for the classification.
The neural network that adjusts best to our
application is the multilayer network. We chose to
train our network by the backpropagation algorithm
[11, 39, 40, 41].
The architecture of the network that we had
trained includes 14 nudes in its entry layer,
corresponding to the 14 selected parameters, only
one hidden layer of seven nudes and one nude to the
output layer giving the nature of the lesion (cf
Figure 3). For the training and the test, we used
several combinations of two wholes of individuals
that are statistically independent.
Output
14 inputs nput Layer Hidden Layer Output
7 neurons Laver
Figure3: Architecture of the used neural network.
7. Experimental results
The dermatologist usually uses slides for lesion
image storage. Our database has been collected in
France with the collaboration of PSI-INSA Rouen
research laboratory and supported by the French
Ligue Nationale contre le Cancer. We use 62 images
of benign and malignant lesions. The images were
digitized in true RGB color with a 35 mm film
scanner Nikon LS-1000. The results of thresholding
and classification algorithms were described in
previous works [11, 20].
We use snake technique described in paragraph 4
to perform automatic edge detection of pigmented
skin lesions of different types. Results are reported in
Tablel. The snake begins with the calculation of a
field of external forces over the image domain. The
snake starts at the approximate boundary of safe skin
obtained by the pre-processing step. The forces drive
it toward the boundary of the lesion. The process is
iterated until it matches the contour of the lesion. We
superpose the obtained contour on the original color
image.
After pre-processing of images by Gaussian and
median filtering, we segmented the set of images
while using our automatic approach of segmentation
based on morphological filters and snake (cf figure2).
Then, lesions have been summarized in vectors of 14
parameters that served like entries for training and
test stages.
The classification had been tested on a set of 60
lesions whose malign or benign nature is perfectly
known after histological analysis. Every class of
lesions contributes, by the same percentage of its
total number, to the sample of training and the one of
test.
Parameters kept for the classification issues of
clinics descriptions given by dermatologists (ABCD
rule). From a list of 68 quantitative parameters we
selected 14 parameters that verify statistical and
hardiness criteria that we defined.
The classification by neural network (NN) has
been achieved for different combinations of lesion
images for samples of training and test. We used,
respectively, percentages of (60/40), (70/30) and
(80/20) for training and test databases. For every case
we formed different combinations whose individuals
were chosen uncertainly. One gave results of tests in
table2.
To complete the survey of the relevant retained
parameter at the classification level we did the
following test: to the entry of the NN we put to zero,
one by one, the entries corresponding to each of the
14 parameters.
We do, at every time the steps of training and test.
We gave the number of badly classified lesions
following
the set to zero of every parameter. More the
percentage of good recognition falls, more the
relevance of the parameter will be considered
important. The decreasing order of pertinence of
variables is given in table 3. We notice that the
sharpness report (rf) is most pertinent and that the
middle level of the red (rmoyL) is the least pertinent.
To decide on the nature of a new case of lesion,
we have only to extract in an automatic way the 14
parameters of description of the lesion. These
parameters are then used like entries for the NN
classifier and the lesion will be classified
automatically. The training had been already

(b)
Step 1. (a) Malign pigmented skin lesion, (b) thresholding
(d) Skin lesion region obtained.

(f)
i.......

_ X . of
..

~~._
...............

*.~ ~

X~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~image,
_ ,the

~~~~~~~~~(g)
~~
...

~ ~~
..

(a)

~ ~~

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ......

Step2 .(e) Initial snake boundary, (f) Output of snake deformation process, (g) Final skin lesion border.
Figurel. Hybrid Segmented Image using thresholding (Otsu Method) and snakes.
...j

~ ~~

()(d)
achieved while exploiting the knowledge database.

~~~ ~~~ ~~~ ~~~ ~~~

(c) application of morphological opening,

~~~ ~~~ ~~~ ~~~ ~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~..

(e)
 I0*l'=.
..........lli
.........
..

(b)

(e)()
i i ii __,jj..Im...... ...

(a)

(c)
...

(d)

Step 1. (a) Malign pigmented skin lesion, (b) gray level image, (c) image obtained after top-hat and bottom-hat
transforms, (d) image containing only the intensity valleys deeper than a particular threshold, (e) application of
morphological opening ,(f) Skin lesion region.

(h) (f)
Step 21. (g) Intalg simnaked
boundaryio,
(h)Otpto snake deformation prcess
(i)g Finasine lfesiobor-atader.tm-a
Figure 2. Hybrid Segmented Image using morphol gy functions and snakes.
Original Images Segmented Images Segmented Images
using thresholding using thresholding using morphology
.................. ........
(Otsu Method) and snakes functions and snakes

...0

............

.........M

....

,HN

ME

RMI.

M.'1.'1.'1.'1.'1.'M1'1

................
Tablet- comparison between automatic ed e detection method of skin lesions
60/40 70/30 80/20
°/% of lesions / samples
Min Max Min Max Min Max
FP 1 1 1 0 0 0
VP 9 12 7 9 5 6
FN 3 0 2 0 1 0
VN 11 11 8 9 6 6
% of recognition 83,3 95,8 83,3 100 91,6 100
Mean of the percentages 89,5 91,65 95,8
of recognition__

Table 2: Percentage of lesion recognition during the test

- FP (False Positive) badly classified Benign Lesion.

- VP (True Positive) well classified malign Lesion.

- FN (False Negative) badly classified malign Lesion.

- VN (True Negative) well classified Benign Lesion.

% of rf rc scR Em Delta scB bmoyL conc scv er Alpha scG eb rmoyL

lesions/parameterT
ls

FP 0 2 2 1 3 2 2 2 2 0 1 1 1 1

VP 3 8 8 18 10 9 9 10 10 8 10 10 10 10
FN 7 2 2 2 0 1 1 0 0 2 0 0 0 0
VN 10 8 8 9 7 8 8 8 8 10 9 9 9 9

0% of recognition 65 80 80 85 85 85 85 90 90 90 95 95 95 95

Table 3: Influence of parameters on the classification of lesions.

8. Conclusions neural network, in the entire process of melanoma

In this paper we have described the different steps
used in CAD system in melanoma detection. To
make this tool useful by the dermatologist
community outside specialized centres, each stage of
processing has to be automatic. Our hybrid approach
of segmentation based on morphology functions and
snakes can be integrated, with classification using the
Appendice
* List of parameters
1. The geometric parameters
- Sharpness Report (rf): characterizes the shape of
the lesion, it measures its divergence in relation to a
detection to replace supervised used methods.
Acknowledgment
We thank the expert dermatologists Professor
Pascal Joly and Professor Ph Lauret from the hospital
CHU de Rouen France for the data base of slides.
circular shape. It expresses itself according to its
surface, S and its perimeter, P:
rf 2()
- The regularity of the contour (rc):
A contour C is regular if it presents neither no The standard deviation cc of the distribution of C,
distortion nor notch. It is characterized by: is:

p Z' (p
peC
) (2)
2) pEL
(P)- ( 9

Where C is the mean of levels of C calculated on the

where P is the perimeter of the lesion, d is the mean lesion.
euclidian distance to its center of gravity G of
where p (i, j)j is a pixel given
coriae(, coordinate - The divergence between the average of the color
of itscontour C.
'i of the lesion and the one of the skin:
We define the parameter ec, that expresses the
d =-L d(p) divergence between the average of a photometric
p (3) variable, within a lesion and its average within the
safe skin surrounding the lesion.
d2 =(_ 2+_J (4) ec=CS C (10

-The extent (Ad): for the distance. where CL et Cs are respectively the averages of
dmax- din the color on the lesion and on the surrounding safe
Ad =
(5) skin;
cwcs is the standard deviation of C calculated on the
where diax and dmin represents respectively the safe skin. The normalization by the standard
maximal and minimal euclidian distance of points of deviation has been introduced because the dynamics
contour to the center of gravity G of the lesion. of gray levels varies from an image to another.
- The middle divergence (Em): _______
1heE d(p) (E-
divergence

I
The symmetry of the color
- dl The difference between the means of distances to the
Em ~ pEC (6) center of gravity of the lesion, of the darkest pixels
m -
d and the clearest pixels constitutes a means to measure
the symmetry sc of the color within a lesion
where P is the perimeter of the lesion. d(p) is the
euclidian distance of a given pixel p of the lesion to
its center of gravity G.
d -d (1s 1)
- The index of concavity (conc): The indication of c d
concavity in surface is a measure of the distribution
of the lesion on the polygon in which it is written where ds and dc the respective averages of distances
down. For a disk of ray wrote down in a square to the center of gravity of the darkest and clearest
(n=4), the surface of the square is (2a)2 = 4a2 and the pixels .
surface of the disc is na 2, the indication of dG is the normalization by the mean of the distance
concavity in surface is: to the center of gravity G of the lesion.
2
-( aa)2 w- (7) spherical coordinate (Alpha) is expressed
C= -
YThe
-

-1 B
2. The photometric parameters a =cos (12)
the mean C for the distribution of a variable C in a
lesion L, is: W

SpeL
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