An insight into racial bias in dermoscopy repositories: A HAM10000 data set analysis

ABSTRACT: Background Studies have revealed a lack of representation of skin of colour patients in academic sources of dermatologic diseases, including databases. This visual racism has consequently generated less comfort and confidence among the specialists in the care and attention of this ethnic group, including the opportunity of being correctly diagnosed. Objectives To investigate and uncover potential racial biases in the HAM10000 data set through an exploratory analysis of the dark skin tones representation, the identification of inaccuracies in its documentation, the recognition of relevant skin conditions absent for darker skin and the lack of ethnic diversity variables crucial for validating diagnosis across different skin tones. Methods An exploratory examination was conducted to investigate the occurrence of dark skin within the HAM10000 database (housed in a Harvard Dataverse repository), consisting of 10,015 dermoscopic images of skin lesions. A visual depiction encompassing the whole skin tones was generated by sampling four crucial data points from each image and applying the Gray World Algorithm for colour normalization. To confirm the accuracy of the graphical representation, dermatologists validated the pixel sampling process by analysing a randomly selected 10% of the images for each type of skin lesion. This visual representation was produced for the entire data set as well as for each skin lesion type. The study was further enhanced by comparing the skin lesion representation within the HAM10000 data set against documented prevalences of relevant conditions affecting dark skin. Results Less than 5% of the images came from dark-skinned patients. Nevertheless, in about 4.9% of cases, our pixel sampling method might inadvertently capture shadows or dark spots resulting from the imaging device or the lesion itself rather than the individual's actual skin tone. In addition, there are inaccuracies in the data set's claims of diversity and comprehensive coverage, notably the underrepresentation of conditions prevalent in darker skin and the absence of ethnic diversity variables. Conclusions Visual racism is an issue that needs to be addressed in medical sources of information and education. Image databases and artificial intelligence models need to be nourished with information, including all skin types, to guarantee equal access to opportunities. Furthermore, any instances where conditions affecting people of colour are underrepresented must be meticulously documented and reported to highlight and address these disparities effectively. This is particularly important in dermoscopy imaging, where solely relying on image-based racial bias analysis is limited. The alteration of the patient's actual skin tone by the dermatoscope's lighting complicates the accurate assessment of racial bias

Fístula arteriovenosa traumática del cuero cabelludo tras implantación capilar tratada con éxito mediante agente embólico PHIL

Antecedentes: La fístula arteriovenosa traumática del cuero cabelludo por trasplante capilar (FAVT) es una rara comunicación fistulosa entre ramas de las arterias y venas de drenaje en el tejido subcutáneo del cuero cabelludo. Su incidencia es desconocida y sus manifestaciones clínicas pueden ir desde una masa pulsátil hasta, en raras ocasiones, epilepsia. Como opciones de tratamiento se han utilizado la cirugía y los abordajes intervencionistas (embolización percutánea y endovascular) mediante espirales y agentes embólicos como el Onyx. e autores informan de un caso poco frecuente de una AVFHT tratada con éxito mediante embolización percutánea y endovascular utilizando coils y agente embólico líquido inyectable hidrófobo precipitante (PHIL). is es posiblemente el primer caso descrito en el que se utiliza el agente embólico PHIL para tratar una AVFHT. Descripción del caso: e paciente presentó una inflamación del cuero cabelludo dolorosa e incapacitante en la región parieto-occipital derecha 2 años después de un trasplante capilar en 2011. Una angiografía por tomografía computarizada mostró una fístula arteriovenosa entre ramas de la arteria temporal superficial derecha y ramas de la arteria occipital derecha a la vena temporal superficial derecha que se embolizó con éxito utilizando coils y PHIL. e paciente fue dado de alta tras una recuperación sin complicaciones y 1 mes después permanecía sano. Conclusiones: La embolización percutánea y endovascular utilizando el agente embólico PHIL puede ser un tratamiento alternativo para la AVFHT.Background: A traumatic arteriovenous fistula of the scalp due to hair transplantation (AVFHT) is a rare fistulous communication between branches of the arteries and draining veins in the scalp’s subcutaneous tissue. Its incidence is unknown and its clinical manifestations may range from a pulsatile mass to seldom epilepsy. Surgery and interventional approaches (percutaneous and endovascular embolization) using coils and embolic agents such as Onyx have been used as treatment options. e authors report a rare case of an AVFHT successfully treated through percutaneous and endovascular embolization using coils and precipitating hydrophobic injectable liquid (PHIL) embolic agent. is is possibly the first reported case using PHIL embolic agent to treat an AVFHT. Case Description: e patient presented with a painful and disabling scalp swelling in the right parieto-occipital region 2 years after a hair transplant in 2011. A computed tomography angiography showed an arteriovenous f istula between branches of the right superficial temporal artery and branches of the right occipital artery to the right superficial temporal vein that was successfully embolized using coils and PHIL. e patient was discharged after a smooth recovery and 1 month later remained healthy. Conclusion: Percutaneous and endovascular embolization using PHIL embolic agent can be an alternative treatment for AVFHT