Contrast-Induced Class Overlap as a Fairness Bottleneck in Dermatological AI: Evidence from HAM10000
This study identifies that lower lesion-background contrast on darker skin creates a structural class overlap causing AI dermatological models to systematically over-predict malignancy and generate excess referrals for darker-skinned patients, a fairness bottleneck that persists even after correcting for confounding class distributions and is best mitigated by per-tone class balancing rather than tone conditioning.