The Online Journal on Electronics and Electrical Engineering (OJEEE)

Vol. (3) No. (2)

Uncertainty in Skin Lesions Segmentation

N. A. Masood (1), H. M. Mashali (2), Abdalla S. A. Mohamed (3)
1

Department of Medical Engineering, Faculty of Engineering, Menia University

E-mail: nsreen_masood@yahoo.com
2
Department of Dermatology, Faculty of Medicine, Cairo University
3
Department of Systems &Biomedical Engineering, Faculty of Engineering, Cairo University
E-mail: profabdo@gmail.com
Abstract- Differential diagnosis of skin lesions diseases
is considered a real problem in dermatology. The method
for skin lesion segmentation will influence the efficiency
of skin diseases classification and diagnosis. This paper
focuses on uncertainties in skin lesions segmentation and
their visualization. The first part aims to select set of
segmentation techniques namely: k-means clustering,
rough sets approach, topological derivatives, and
watershed for testing and selecting the most appropriate
one. The evaluation of each one depends on a comparison
of its output with the manual output by experts in
dermatology. The aim of the second part of this study is to
quantify their uncertainties with three different
erythemato- squamous diseases. Existential lesion
uncertainty is determined by boundary pixels. ROC is
applied as a suitable measure to determine the output
accuracy for each technique based on determined lesions
boundaries. Rough sets approach provides good
segmentation results with 94 % accuracy and sensitivity
96%.
Keywords- Atopic dermatitis, Pityriasis Rosea,
Pityriasis Rubra Pilaris, discernibility function, level set
method, watershed, k- means, ROC.
I.

INTRODUCTION

Erythemato-squamous diseases contain six groups of

diseases and they are: Psoreasis (PS), Seborrheic Dermatitis
(SD), Lichen Planus (LP), Pityriasis Rosea (PR), Chronic
Dermatitis, and Pityriasis Rubra Pilaris (PRP). These groups
of diseases give difficulties in their diagnosis since they all
share the clinical features of erythema and scaling, with very
little differences.
In this study, we replace Chronic
Dermatitis disease with Atopic Dermatitis (AD) due to the
abundance of its images and its frequent occurrence in our
country [1]. Skin lesions can cover large areas of the body
and have component of ulceration, either solitary or wide
spread. The determination of the degree of infection has
always been problematic for dermatologists who use
medications to prevent or decrease that degree in patients
where dermatologist relies on his clinical experience or visual
perception [2].
The processes of skin image analysis involve isolating
lesions in an image from healthy skin and analyze them for
some visual features. Traditional methods used for skin
examination are inefficient where clinical evaluation of skin

Reference Number: W10-0085

lesions is based on common sense and memory of the

dermatologist to differentiate appearance of skin independent
of human race (normal skin color) and in the presence of
blotches, hair, wrinkles, etc.
This paper will introduce four different color segmentation
techniques namely: k-means clustering, rough sets,
topological derivative and watershed. The comparison among
these approaches is based on calculating the accuracy and
sensitivity of these approaches for each group of disease.
ROC curve is also presented for individual technique to show
its predictability. Problem description is explained in
sectionI. Introductory remarks for the selected segmentation
techniques are given in sectionIII. Results and discussions are
given in sectionIV. Conclusions are outlined in sectionV.
II.

PROBLEM DESCRIPTION

Colored skin images can provide valuable source of

information for diagnosing state of skin and prognoseing
body health. Advances in colored imaging systems
(compared to gray level images) now allow us to detect
different lesions and derive information from the physical
appearance of the surface such as redness (inflammation)
presence of ulcers, etc. This makes skin images suitable for
clinical diagnosis. For this purpose, an important stage in
image processing is the segmentation of skin lesions.
Based on segmented regions, classification of these regions
will result by reducing a multiplicity of phenomena to a
relative small number of general classes. Therefore,
sensitivity of segmentation technique to noise will affect the
accuracy of segmented lesions. Here, noise leads to
uncertainty, which can eventually and significantly affect the
knowledge extracted from data.
The problem can be described as follows: Given a set of
original images with skin lesions as shown in Figures (1-3),
we have not any additional information other than the pure
image. It is required to determine states of dermal surface
which represents the severity of infection present in the
surface. Moreover, there is a great need to isolate these
lesions from healthy skin avoiding the confusion from
interference of other factors as race (normal skin color),
blotches, hair, and wrinkles to achieve visual competence
near the level of human being. Moreover, due to the lack of a
common data set, a wide diversity of objectives, lack of
meaningful evaluation, and inconsistencies in the use of
image models will be resulted. This makes the correction

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The Online Journal on Electronics and Electrical Engineering (OJEEE)

segmented regions by different

algorithms a difficult task [3-4].
III.

image

segmentation

SELECTED SEGMENTATION
TECHNIQUES

A. K-means Clustering
K-means clustering technique is a well known and an
elementary method that computes the k-means of any number
of clusters in any data sets. Here, it is used for color image
segmentation, where it partitions the colors of the image into
k-clusters and calculates the center of each cluster by taking
its mean to represent it. It is an intuitive way of classifying
image pixels into classes or groups (provided the number of
classes is known a priori). It depends on using Euclidean
distance between the pixel and class means based on the
nearest neighbor approach for classification. The basic idea
behind the nearest neighbor rule is that pixels, which fall,
close together are likely to belong to the same class [5]. The
sum of the squared distance between the pixel vector and the
class mean vectors is used as a method of distance
comparison. In this work k-means clustering performs the
segmentation process based on partitioning the color map
into only three clusters (colors are their centers).
B. Rough Set
Dealing with vagueness (i.e. intrinsic uncertainty) is an
important part in reasoning and data analysis logic. A concept
is vague (i.e. not crisp), if it cannot be expressed by some
certain or true concept. Vague concepts have attracted the
attention of researchers for long time since crisp concepts
cannot deal with the uncertain matter of the universe. Rough
sets introduced by Pawlak [6-7] and its extensions are a new
mathematical concept meant to be used in reasoning about
uncertain or vague knowledge. It is used to analyze
incomplete, imprecise, and uncertain and vague data [8].
Data grouping is one of the strong assets of this approach
where it allows the organization of data into easily
recognizable and defined partitions (groups) and gives a
measure of closeness and inclusion of groups in an infinite
universe. In addition to partitioning of data, rough set
determines the boundary region of vagueness. A boundary
region consists of all elements which cannot be defined by
the available concepts [9-10].
When we know what characteristics differ one object from
the other, we are able to qualify objects by looking at their
attribute values [11]. So it is necessary to search for
differences between objects. If we list all objects on the row
axis and the column axis, the discernibility matrix is
constructed. In each entry of the matrix, we state the
differences between the object corresponding to the row axis
and the object corresponding to the column axis. Details for
the implementation of this approach are available in [12].
C. Topological Derivative
Topological Derivative (TD) allows us to quantify the
sensitivity of a problem when the domain under consideration
is perturbed by the introduction of a heterogeneity (hole,

Reference Number: W10-0085

Vol. (3) No. (2)

inclusion, source term, etc.). In particular Topological

Derivative is used as a descent direction to minimize the
associated cost function, leading to a new image
segmentation algorithm [13]. The introduction of the
Topological Derivative, originally conceived for the study of
topology optimization problems, has shown interesting
results when applied to image processing [14-15]. In this
work an image segmentation algorithm based on this
derivative is proposed. derivative is proposed. Let J () = J
( ()) be the cost function to be minimized and () the
solution of an associated variational problem (VP) dened in
the domain . For a small parameter 0, let be the
perturbed domain obtained by the insertion of heterogeneity
on the parameters governing the associated VP. This
heterogeneity is dened in a small ball of radius centered at
any point x of the domain W. Let be the solution of the VP
defined in the perturbed domain . Then, for small values of
parameter , the topological sensitivity provides an
asymptotic expansion of J ():
J () = J() + f() DT(x) + o(f())

(1)

where f() is a known positive function going monotonically

to zero with and DT(x) is the topological derivative.
Therefore, this derivative can be seen as a rst order
correction on J () to estimate J (). Since f () is positive,
the heterogeneity must be introduced at any point x where DT
is negative in order to reduce the value of the cost function J.
D. Watershed
The watershed transform [16] is a popular segmentation
method coming from the field of mathematical morphology.
To describe this transform; consider the image as a
topographic relief, where the height of each point is directly
related to its gray level, and consider rain gradually falling on
the terrain, then the watersheds are the lines that separate the
lakes (actually called catchment basins) that form.
Generally, the watershed transform is computed on the
gradient of the original image, so that the catchment basin
boundaries are located at high gradient points.
The watershed transform has been widely used in many
fields of image processing, including medical image
segmentation, due to the number of advantages that it
possesses: it is a simple, intuitive method, it is fast and it
produces a complete division of the image in separated
regions even if the contrast is poor, thus avoiding the need for
any kind of contour joining [17]. Furthermore, several
researchers have proposed techniques to embed the
watershed transform in a multiscale framework, thus
providing the advantages of these representations [18-19].
IV.

RESULTS AND DISCUSSION

In order to test the validity of the selected techniques, we

had selected for each disease (50) images. The selection of
the images was done by expertise in dermatology. Such
selection includes images with various sizes, and variable
colors, lesions have clear and blur borders, dark and light,

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The Online Journal on Electronics and Electrical Engineering (OJEEE)

with and without hair, and other types of noise, etc.

Experiments were carried out to test the agreement between
the results of the proposed techniques and human perception.
Five dermatologists participated in the experiment and
independently reviewed the images before seeing the results
and determined manually the infected regions as shown in
Figs. (1-b,2-b,and 3-b).
It is quite normal in medical research that people need to
measure and test the agreement between observers when they
rate or evaluate a group of persons independently [20].
Validation of the resulting segmented regions is necessary to
assess segmentation accuracy. Lesions (regions) boundaries
in segmented edge pixels are determined and assigned the
value (1) and non-boundary pixels the value (0) as shown in
Figs.(1-c, 2-c,and 3-c). To quantitatively assess a
segmentation result, region boundaries from the identified
reference images are compared with segmented regions by
the selected techniques. True [T] regions, false [F] regions,
and receiver operating characteristic [ROC] as statistical tool
to assess the accuracy of predictions were calculated.
Sensitivity, and Accuracy or Precision defined in [21] as
statistical measures of the performance of these techniques
were calculated and the corresponding receiver operating
characteristic curves [ROC] are illustrated in Figures (4, 5,
and 6) for the three group of diseases.
Table-1 shows a comparison among the four segmentation
techniques applied to the three groups of diseases.
Table (1): Comparison among the segmentation
techniques
Disease
Technique
Accuracy
Sensitivity
(50%)
(56%)
K-means
Rough Set
(86%)
(88%)
AD
(66%)
(74%)
TD
(62%)
(68%)
Watershed
(46%)
(62%)
K-means
(84%)
Rough Set
(80%)
PR
(50%)
(58%)
TD
(54%)
(82%)
Watershed
(54%)
(50%)
K-means
Rough Set
(94%)
(96%)
PRP
(78%)
(76%)
TD
(82%)
(88%)
Watershed

(a) Original image

Vol. (3) No. (2)

(b) Refererence segmentation

(c) Rough set segmentation

(d) K-means segmentation

(e) Watershed segmentation

(f) TD segmentation
Figure (1): Comparison among rough set, k-means,
watershed and TD approaches for AD disease

(a) Original image

(c) Rough set segmentation

(b) Reference segmentation

(d) K-means segmentation

(e) Watershed segmentation

(f) TD segmentation
Figure (2): Comparison among rough set, k-means,
watershed and TD approaches for PR disease

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Vol. (3) No. (2)

ROC for the four s egm entation tec hniques applied to P RP

1
0.9
0.8
K -m eans
Rough S et
TD
W aters hed

0.7

TP R

0.6
0.5
0.4
0.3

(a) Original image

(b) Reference segmentation

0.2
0.1
0

0.1

0.2

0.3

0.4

0.5
FP R

0.6

0.7

0.8

0.9

Figure (6): ROC for the four techniques applied to PRP

(c) Rough set segmentation

(d) K-means segmentation

The main advantage of rough set theory is that it does not

need any preliminary or additional information about data
like probability in statistics, basic probability number in
Dempster-Shafer theory, grade of membership, or the value
of possibility in fuzzy set theory. Other advantages of the
rough set approach include its ease of handling and its
simplicity.
V.

(e) Watershed segmentation

(f) TD segmentation
Figure (3): Comparison among rough set, k-means,
watershed and TD approaches for PRP disease
ROC for the four s egm entation tec hniques applied to A D
1
0.9
0.8

Uncertainty plays an important role in skin lesions

segmentation. Low precision of segmented regions usually
result from low sensitivity and inaccurate segmentation
techniques. Rough sets approach provides an excellent means
of exploring skin lesions and excluding related uncertainty.
The user can interactively apply the discernability function
which dynamically links the regions and consequently
improves the insight uncertainty information.

0.7

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0.5
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