Nature Communications

Dermatologist-like explainable AI enhances melanoma diagnosis accuracy: eye-tracking study

T Tirtha Chanda S Sarah Haggenmueller T Tabea-Clara Bucher T Tim Holland-Letz H Harald Kittler P Philipp Tschandl M Markus V. Heppt C Carola Berking J Jochen S. Utikal B Bastian Schilling C Claudia Buerger C Cristian Navarrete-Dechent M Matthias Goebeler J Jakob Nikolas Kather C Carolin V. Schneider B Benjamin Durani H Hendrike Durani M Martin Jansen J Juliane Wacker J Joerg Wacker N Nina Booken V Verena Ahlgrimm-Siess J Julia Welzel O Oana-Diana Persa F Florentia Dimitriou L Lara Valeska Maul A Antonia Reimer-Taschenbrecker S Sandra Schuh F Falk G. Bechara L Laurence Feldmeyer B Beda Mühleisen E Elisabeth Gössinger S Stephan Alexander Braun V Van Anh Nguyen (Takeda Development Center Americas, Cambridge, MA) J Julia-Tatjana Maul F Friederike Hoffmann C Claudia Pföhler J Janis Thamm W Wiebke Ludwig-Peitsch D Daniela Hartmann L Laura Garzona-Navas M Martyna Sławińska P Panagiota Theofilogiannakou A Ana Sanader Vucemilovic J Juan José Lluch-Galcerá A Aude Beyens D Dilara Ilhan Erdil R Rym Afiouni V Vanda Bondare-Ansberga M Martha Alejandra Morales-Sánchez A Arzu Ferhatosmanoğlu R Roque Rafael Oliveira Neto L Lidija Petrovska A Amalia Tsakiri H Hülya Cenk S Sharon Hudson M Miroslav Dragolov Z Zorica Zafirovik I Ivana Jocic A Alise Balcere Z Zsuzsanna Lengyel A Alexander Salava I Isabelle Hoorens S Sonia Rodriguez Saa E Emõke Rácz G Gabriel Salerni K Karen Manuelyan A Amr Mohammad Ammar M Michael Erdmann (Department of Dermatology, Uniklinikum Erlangen, Friedrich Alexander University) N Nicola Wagner J Jannik Sambale S Stephan Kemenes M Moritz Ronicke L Lukas Sollfrank C Caroline Bosch-Voskens I Ioannis Sagonas T Thomas Breakell C Christopher Uebel L Lisa Zieringer M Michael Hoener L Leonie Rabe T Tim Sackmann J Julia Baumert M Marthe Lisa Schaarschmidt N Nadia Ninosu K Kaan Yilmaz D Danai Dionysia F Franca Christ S Sarah Fahimi S Sabina Loos A Ani Sachweizer J Janika Gosmann T Tobias Weberschock U Ufuk Erdogdu A Amelie Buchinger J Jasmin Lunderstedt T Timo Funk H Hess Klifo S Sebastian Kiefer D Dietlein Klifo M Malin Kalski T Titus J. Brinker

Abstract

Abstract Artificial intelligence (AI) systems substantially improve dermatologists’ diagnostic accuracy for melanoma, with explainable AI (XAI) systems further enhancing their confidence and trust in AI-driven decisions. Despite these advancements, there remains a critical need for objective evaluation of how dermatologists engage with both AI and XAI tools. In this study, 76 dermatologists participate in a reader study, diagnosing 16 dermoscopic images of melanomas and nevi using an XAI system that provides detailed, domain-specific explanations, while eye-tracking technology assesses their interactions. Diagnostic performance is compared with that of a standard AI system lacking explanatory features. Here we show that XAI significantly improves dermatologists’ diagnostic balanced accuracy by 2.8 percentage points compared to standard AI. Moreover, diagnostic disagreements with AI/XAI systems and complex lesions are associated with elevated cognitive load, as evidenced by increased ocular fixations. These insights have significant implications for the design of AI/XAI tools for visual tasks in dermatology and the broader development of XAI in medical diagnostics.

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Article Details

Volume / Issue Vol. 16, Issue 1
Published May 21, 2025
ISSN 2041-1723
Publisher Nature Portfolio

Journal Info

Nature Communications

Nature Portfolio
ISSN: 2041-1723 Open Access Life Sciences

Authors (102)

T

Tirtha Chanda

S

Sarah Haggenmueller

T

Tabea-Clara Bucher

T

Tim Holland-Letz

H

Harald Kittler

P

Philipp Tschandl

M

Markus V. Heppt

C

Carola Berking

J

Jochen S. Utikal

B

Bastian Schilling

C

Claudia Buerger

C

Cristian Navarrete-Dechent

M

Matthias Goebeler

J

Jakob Nikolas Kather

C

Carolin V. Schneider

B

Benjamin Durani

H

Hendrike Durani

M

Martin Jansen

J

Juliane Wacker

J

Joerg Wacker

N

Nina Booken

V

Verena Ahlgrimm-Siess

J

Julia Welzel

O

Oana-Diana Persa

F

Florentia Dimitriou

L

Lara Valeska Maul

A

Antonia Reimer-Taschenbrecker

S

Sandra Schuh

F

Falk G. Bechara

L

Laurence Feldmeyer

B

Beda Mühleisen

E

Elisabeth Gössinger

S

Stephan Alexander Braun

V

Van Anh Nguyen

Takeda Development Center Americas, Cambridge, MA

J

Julia-Tatjana Maul

F

Friederike Hoffmann

C

Claudia Pföhler

J

Janis Thamm

W

Wiebke Ludwig-Peitsch

D

Daniela Hartmann

L

Laura Garzona-Navas

M

Martyna Sławińska

P

Panagiota Theofilogiannakou

A

Ana Sanader Vucemilovic

J

Juan José Lluch-Galcerá

A

Aude Beyens

D

Dilara Ilhan Erdil

R

Rym Afiouni

V

Vanda Bondare-Ansberga

M

Martha Alejandra Morales-Sánchez

A

Arzu Ferhatosmanoğlu

R

Roque Rafael Oliveira Neto

L

Lidija Petrovska

A

Amalia Tsakiri

H

Hülya Cenk

S

Sharon Hudson

M

Miroslav Dragolov

Z

Zorica Zafirovik

I

Ivana Jocic

A

Alise Balcere

Z

Zsuzsanna Lengyel

A

Alexander Salava

I

Isabelle Hoorens

S

Sonia Rodriguez Saa

E

Emõke Rácz

G

Gabriel Salerni

K

Karen Manuelyan

A

Amr Mohammad Ammar

M

Michael Erdmann

Department of Dermatology, Uniklinikum Erlangen, Friedrich Alexander University

N

Nicola Wagner

J

Jannik Sambale

S

Stephan Kemenes

M

Moritz Ronicke

L

Lukas Sollfrank

C

Caroline Bosch-Voskens

I

Ioannis Sagonas

T

Thomas Breakell

C

Christopher Uebel

L

Lisa Zieringer

M

Michael Hoener

L

Leonie Rabe

T

Tim Sackmann

J

Julia Baumert

M

Marthe Lisa Schaarschmidt

N

Nadia Ninosu

K

Kaan Yilmaz

D

Danai Dionysia

F

Franca Christ

S

Sarah Fahimi

S

Sabina Loos

A

Ani Sachweizer

J

Janika Gosmann

T

Tobias Weberschock

U

Ufuk Erdogdu

A

Amelie Buchinger

J

Jasmin Lunderstedt

T

Timo Funk

H

Hess Klifo

S

Sebastian Kiefer

D

Dietlein Klifo

M

Malin Kalski

T

Titus J. Brinker

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