Purpose: Mpox is a viral illness with symptoms similar to smallpox. A key clinical metric to monitor disease progression is the number of skin lesions. Manually counting mpox skin lesions is labor-intensive and susceptible to human error.
Approach: We previously developed an mpox lesion counting method based on the UNet segmentation model using 66 photographs from 18 patients. We have compared four additional methods: the instance segmentation methods Mask R-CNN, YOLOv8, and E2EC, in addition to a UNet++ model. We designed a patient-level leave-one-out experiment, assessing their performance using score and lesion count metrics. Finally, we tested whether an ensemble of the networks outperformed any single model.
Results: Mask R-CNN model achieved an score of 0.75, YOLOv8 a score of 0.75, E2EC a score of 0.70, UNet++ a score of 0.81, and baseline UNet a score of 0.79. Bland-Altman analysis of lesion count performance showed a limit of agreement (LoA) width of 62.2 for Mask R-CNN, 91.3 for YOLOv8, 94.2 for E2EC, and 62.1 for UNet++, with the baseline UNet model achieving 69.1. The ensemble showed an score performance of 0.78 and LoA width of 67.4.
Conclusions: Instance segmentation methods and UNet-based semantic segmentation methods performed equally well in lesion counting. Furthermore, the ensemble of the trained models showed no performance increase over the best-performing model UNet, likely because errors are frequently shared across models. Performance is likely limited by the availability of high-quality photographs for this complex problem, rather than the methodologies used.
Keywords: comparative study; deep learning; dermatology; ensemble methods; lesion counting; mpox.
© 2025 The Authors.