Healthcare Analytics 3 (2023) 100199

Contents lists available at ScienceDirect

Healthcare Analytics
journal homepage: www.elsevier.com/locate/health

A Comprehensive assessment of Convolutional Neural Networks for skin and

oral cancer detection using medical images
Dhatri Raval ∗, Jaimin N. Undavia
Smt. Chandaben Mohanbhai Patel Institute of Computer Applications, Faculty of Computer Science and Applications, Charotar University of Science and
Technology, Changa 388421, India

ARTICLE INFO ABSTRACT

Keywords: Early detection is essential to effectively treat two of the most prevalent cancers, skin and oral. Deep learning
Deep learning approaches have demonstrated promising results in effectively detecting these cancers using Computer-Aided
Convolutional Neural Network Cancer Detection (CAD) and medical imagery. This study proposes a deep learning-based method for detecting
Computer-Aided Cancer Detection
skin and oral cancer using medical images. We discuss various Convolutional Neural Network (CNN) models
Data augmentation
such as AlexNet, VGGNet, Inception, ResNet, DenseNet, and Graph Neural Network (GNN). Image processing
Skin cancer
Oral cancer
techniques such as image resizing and image filtering are applied to skin cancer and oral cancer images to
improve the quality and remove noise from images. Data augmentation techniques are used next to expand
the training dataset and strengthen the robustness of the CNN model. The best CNN model is selected based
on the training accuracy, training loss, validation accuracy, and validation loss. The study shows DenseNet
achieves state-of-the-art performance on the skin cancer dataset.

1. Introduction
Skin and oral cancers are significant public health concerns, with
millions of cases diagnosed each year. Early detection and accurate
classification of skin and oral cancers are crucial for effective treatment
and improved patient outcomes. Traditional methods of cancer clas-
sification rely on human experts to visually examine biopsy samples,
which can be time-consuming, subjective, and prone to errors.
In recent years, deep learning techniques have shown promise in
automating cancer classification tasks. Deep learning algorithms can
automatically extract relevant features from large datasets and learn
complex patterns that can be used to accurately classify cancer types.
Deep learning algorithms, including CNNs, can benefit from having
larger datasets for training, but the actual amount of data required
for good results can vary depending on several factors, such as the
complexity of the problem and the architecture of the network.
In some cases, a relatively small dataset can be sufficient if the prob-
lem is simple and the network is not too deep or complex. However,
in other cases, a large dataset may be necessary to train a deep neural
network effectively.
In the case of image classification tasks, having a larger dataset can
help improve the accuracy of the model, but it is not always feasible to
collect or label a large amount of data.
In case of the oral cancer the image dataset is very small, so
achieving good accuracy in oral cancer is difficult.
The main problem definition of this article is to find best suited CNN
model to detect skin cancer from the medical images.
The desire to enhance early detection and diagnosis of skin cancer
and oral cancer, which is one of the most common types of cancer
worldwide, drives the motivation for research on skin cancer detection
using deep learning. Skin cancer can often be successfully treated if
identified early, however the accuracy of the diagnosis is dependent
on the dermatologist who examines the skin lesion.
2. Skin cancer
Skin cancer is a type of cancer that originates in the cells of the skin.
It occurs when the cells in the skin grow uncontrollably, forming a mass
or lesion. Health Organization (WHO), skin cancer is one of the most
common cancers worldwide, with more than 2 million cases reported
each year. The highest incidence rates are typically found in countries
with fair-skinned populations living in areas with high levels of sun
exposure, such as Australia, New Zealand, and South Africa [1].
Cancer incidence rates are higher in fair-skinned populations who
live in countries with high amounts of ultraviolet (UV) radiation from
the sun. This is because fair skin is more vulnerable to UV radiation
and has less melanin, which provides some natural protection against
UV radiation’s adverse effects. As a result, those with pale skin are more
likely to get skin cancer. According to the report of the world cancer

∗ Corresponding author.
E-mail addresses: dhatriraval.mca@charusat.ac.in (D. Raval), jaiminundavia.mca@charusat.ac.in (J.N. Undavia).

https://doi.org/10.1016/j.health.2023.100199
Received 30 March 2023; Received in revised form 5 May 2023; Accepted 17 May 2023

2772-4425/© 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license
(http://creativecommons.org/licenses/by/4.0/).
D. Raval and J.N. Undavia
Fig. 1. Three type of skin cancer [10].
research Australia had the highest case of skin cancer and new zealand
is the second [2].
In India, the incidence of skin cancer is relatively low compared
to other countries, with a reported incidence rate of 0.4–1.0 cases per
100,000 populations. However, the incidence of skin cancer in India
is gradually increasing, primarily due to changes in lifestyle and an
increase in exposure to UV radiation from the sun. According to the
Indian Council of Medical Research (ICMR), the most common type of
skin cancer in India is squamous cell carcinoma, followed by basal cell
carcinoma and melanoma [3,4].
It is essential to note that skin cancer is a preventable disease,
and taking preventive measures can significantly reduce the risk of
developing skin cancer.
Prevention of skin cancer:
• Wear sunscreen: Apply SPF 30 or higher broad-spectrum sun-
screen to all exposed skin, including the face, neck, ears, and
hands.
• Avoid being in direct sunlight between 10 a.m. and 4 p.m., when
the sun’s rays are at their greatest.
• When in the sun, wear protective clothing such as long-sleeved
shirts, trousers and a wide-brimmed hat.
• Avoid tanning beds: Because tanning beds raise the risk of skin
cancer, it is preferable to avoid them entirely.
Therefore, it is crucial to regularly check your skin for any new or
suspicious lesions and to seek medical attention if you notice any
changes or abnormalities [3,5].
There are three main types of skin cancer as shown in Fig. 1: basal
cell carcinoma, squamous cell carcinoma, and melanoma.
Basal cell carcinoma (BCC) is the most common type of skin cancer,
accounting for approximately 80% of all skin cancers. It usually appears
as a small, shiny bump or a patch of red, scaly skin that grows slowly
and rarely spreads to other parts of the body. BCC is usually caused
by long-term exposure to ultraviolet (UV) radiation from the sun or
indoor tanning [6]. As per the American cancer society latest data over
5.4 million basal and squamous cell skin malignancies are diagnosed in
the United States each year. Approximately 8 out of every 10 of these
are basal cell cancers. Squamous cell tumors are less common [7].
Squamous cell carcinoma (SCC) is the second most common type
of skin cancer, accounting for approximately 16% of all skin cancers. It
usually appears as a firm, red nodule or a scaly, crusty lesion that grows
rapidly and can spread to other parts of the body if left untreated. SCC
is also caused by long-term exposure to UV radiation [8].
Melanoma is the least common type of skin cancer, but it is the most
dangerous. It accounts for approximately 4% of all skin cancers but is
responsible for the majority of skin cancer-related deaths. Melanoma
usually appears as a dark, irregularly shaped mole that grows quickly
and can spread to other parts of the body. Melanoma is caused by a
combination of genetic factors and exposure to UV radiation [3,5,9]
If there is any mole, wound on skin which not heal and showing
characteristics as mentioned in Table 1 having high risk of skin cancer.
Skin cancer can be detected early through regular self-examination
and screening by a dermatologist. The American Cancer Society recom-
mends that individuals perform self-exams of their skin every month to
look for any new or changing moles or spots. Dermatologists may also
2
Healthcare Analytics 3 (2023) 100199
Table 1
Characteristics of skin cancer [11].
Characteristics Description
A — Asymmetry: One half of the mole or lesion is different from the
other half.
B — Border The edges of the mole or lesion are uneven or not
irregularity: well defined.
C — Color variation: The mole or lesion has different shades of brown,
black, or other colors, or it may have areas of white,
gray, pink, or red.
D — Diameter: The mole or lesion is larger than the size of a pencil
eraser.
E — Evolving: The mole or lesion is changing in size, shape, or color.
F — Firmness: The mole or lesion feels firm or raised.
G — Growing: The mole or lesion is growing rapidly or has
increased in size.
use various techniques to examine the skin, such as a dermatoscope or
a biopsy, to accurately diagnose skin cancer.
It is important to note that not all skin cancers may exhibit these
characteristics, and not all moles or lesions that show these character-
istics are cancerous. Therefore, it is essential to regularly check skin
for any new or suspicious lesions and to seek medical attention if one
notice any changes or abnormalities. A dermatologist or healthcare pro-
fessional can perform a proper diagnosis and recommend appropriate
treatment options [12,13].
Person with malignant melanoma benefit tremendously from early
identification. Although the ABCD assessments are useful in determin-
ing which pigmented lesions require surgery, the differential diagnosis
of pigmented lesions is difficult. The most important risk factor for all
skin neoplasms remains sun exposure. Thus, people should be taught
basic precautions such as avoiding the sun during peak ultraviolet (UV)
B hours, wearing sunscreen and protective clothing, and avoiding sun
tanning.
By detecting the cancer in early stage there are chance of better
treatment, increased the survival rate of person.
In this article, studied to detect skin cancer which are basal cell
carcinoma, Squamous cell carcinoma, and malignant melanoma.
3. Oral cancer
Oral cancer refers to any malignant tumor that develops in the
mouth or throat, which can include the lips, tongue, gums, cheeks, floor
of the mouth, hard and soft palate, and tonsils. There are several types
of oral cancer, including:
Squamous cell carcinoma: This is the most common type of oral cancer,
accounting for more than 90% of cases. It usually starts in the squamous
cells, which are the thin, flat cells lining the surface of the mouth and
throat.
Verrucous carcinoma: This type of cancer is rare and grows slowly. It
usually appears as a white or gray lump with a rough, wart-like surface.
Minor salivary gland carcinoma: This type of cancer starts in the minor
salivary glands, which are located throughout the mouth and throat. It
can occur anywhere in the mouth, but is most common in the palate.
Lymphoma: Lymphoma is a cancer of the lymphatic system, which is
part of the immune system. It can occur in the mouth and throat.
Melanoma: This is a rare form of cancer that develops from pigment-
producing cells in the skin or mucous membranes. It can occur in the
mouth or on the lips.
It is important to note that oral cancer can also spread from other
parts of the body, such as the lungs or breast, and develop in the mouth
or throat as a secondary cancer.
According to the World Health Organization, there were approx-
imately 354,864 new cases of oral cancer worldwide in 2020, and
D. Raval and J.N. Undavia Healthcare Analytics 3 (2023) 100199

177,384 deaths from the disease. According to the American Cancer Table 2
Deep Learning approaches with medical images.
Society, in the United States alone, it is estimated that in 2022, About
Reference No of Methodology Accuracy
54,010 new cases of oral cavity and oropharyngeal cancers (including
instance
cancers of the lips, tongue, tonsils, and throat) will be diagnosed and
S. Sharma et al. [27] 569 KNN 95%
about 10,850 deaths will occur from these types of cancers [14–16].
H ela Elmannai et al. [28] 4800 Transfer learning 94.97
Here are some additional statistics about oral cancer: Rahman, A.-u. [29] 1483 Transfer learning 90.02
C.A. Hamm et al. [30] 494 CNN 92
• Oral cancer is the sixth most common cancer in the world. India N. Patel and A. Mishra [31] 85 Back-propagation 98
is contributing one third of total number of oral cancer. Tobacco neural network
H. Xie, et al. [32] 1018 2D-CNN Faster 86
and alcohol usage is one of the key causes. According to the World
R-CNN
Health Organization (WHO), tobacco is used by around 90% Y. Wang et al. [33] 446 ResNet 78
of patients with oral cancer, whether in the form of cigarettes, M. Toğaçar, Z [34] 3297 SVM, CNN 92
chewing tobacco, or snuff. Alcohol use raises the chance of getting
oral cancer, when combined with tobacco use [17].
• Men are twice as likely as women to develop oral cavity and
Regular dental checkups are one of the most effective methods for
oropharyngeal cancers.
detecting oral cancer early. The dentist will look for any abnormalities
• Oral cancer is most commonly diagnosed in people over the age
or questionable spots in the mouth or throat during a dental exam. If a
of 40, although it can occur at any age. The average age at the
concerning spot is discovered, the dentist may perform a biopsy to de-
time of diagnosis is 62 years old.
termine the presence of malignancy. Early detection and treatment can
• Tobacco use is the leading cause of oral cancer, with alcohol use
significantly improve outcomes, so it is important to maintain regular
also being a significant risk factor.
oral cancer screenings and to seek medical attention if you notice any
• Human papillomavirus (HPV) infection is a growing cause of oral
unusual symptoms or changes in your mouth or throat [15,22,23].
cancer, particularly in younger people.
• The five-year survival rate for all stages of oral cavity and oropha- ∙ Complexity of the problem:
ryngeal cancers combined is approximately 66%. However, sur- The level of difficulty in detecting skin cancer through image
vival rates vary depending on the stage of cancer at the time of processing depends on the algorithms and methodologies used.
diagnosis. For example, the five-year survival rate for localized image processing for skin cancer diagnosis involves many phases,
cancers is approximately 84%, while it drops to 39% for cancers including image capture, image preprocessing, feature extraction,
that have spread to distant sites. and classification.
• The use of oral cancer screening tests, such as visual exams and
tissue biopsies, can help detect the disease early and improve ◦ Diversity of Skin lesion: Skin Lesions Vary in Shape, Color,
survival rates. Texture, and Appearance: Skin lesions vary widely in shape,
color, texture, and appearance. Some may be subtle and
Oral cancer is a significant public health concern in India. According to difficult to detect, while others may be evident. Because
the World Health Organization, oral cancer is the most common cancer of this diversity, developing a universal strategy for skin
among men and the third most common cancer among women in India. cancer screening is difficult.
Here are some statistics on oral cancer in India: ◦ Image Quality: The quality of images used for skin cancer
detection might vary greatly depending on the imaging in-
∙ Incidence: In 2020, it was estimated that there were around strument and the circumstances. When the image quality is
77,000 new cases of oral cancer in India. inadequate, accurately detecting and diagnosing skin lesions
∙ Mortality: Oral cancer is responsible for approximately 47,000 might be difficult.
deaths annually in India. ◦ Algorithm Complexity: Image processing techniques such
∙ Age group: Oral cancer affects individuals in their mid-fifties on as edge detection, feature extraction, segmentation, and
average in India, with the incidence rates increasing with age. classification are just a few of the many that can be used
∙ Gender: Men are more likely to develop oral cancer than women. to identify skin cancer. Choosing the best set of algorithms
In fact, the incidence of oral cancer is two times higher among for a specific task might be tricky.
men than women in India.
∙ Tobacco: The use of tobacco products, including smoking and 4. Deep learning recent approaches in Computer-Aided Diagnosis
chewing tobacco, is the primary cause of oral cancer in India. cancer detection (CAD)
∙ Alcohol: Alcohol consumption is also a significant risk factor for
oral cancer in India. Deep learning algorithms achieved promising results in computer
∙ Geographical distribution: Oral cancer is more prevalent in cer- aided cancer diagnosis (CAD) across multiple cancer types [24–26].
tain regions of India, including the northeastern states, Uttar Here are some recent research publications that indicate deep learning’s
Pradesh, and Bihar. potential in this field (see Table 2):
Deep learning models have shown promising results in the field
It is important to note that these statistics are generalizations, and of medical imaging analysis and diagnosis, and skin cancer detection
individual cases may vary depending on a variety of factors, including using deep learning is an active area of research. The development of
the type and stage of cancer, the individual’s overall health, and the accurate and efficient deep learning models for skin cancer detection
effectiveness of treatment [16,18]. could potentially improve the accuracy and speed of diagnosis, making
The difficulty in diagnosing the disease at an early curable stage it easier to detect and treat skin cancer at an early stage [35–37].
has been blamed for the high mortality rate in oral cancer patients.
Furthermore, because early carcinomas are asymptomatic, the majority 5. Literature review
of cases of oral cancer are usually detected in advanced stages . Current
diagnostic methods rely on clinical and histological exams, which have Early detection of skin cancer and oral cancer is critical for suc-
low sensitivity and a high chance of missing malignant lesions in hidden cessful treatment, and Computer-aided diagnosis (CAD) systems can
locations [19–21]. help in the detection of skin cancer. Over the years, various imaging

3
D. Raval and J.N. Undavia
techniques have been developed to help in the early detection of
skin and oral cancer. One of the emerging techniques is the use of
convolutional neural networks (CNNs), which have shown promising
results in detection and classification of skin cancer and oral cancer
from medical images. This literature review aims to explore the use of
CNN in skin cancer and oral cancer detection and classification.
Dermoscopy is a non-invasive imaging technique that has been
widely used for the detection of skin cancer. Several studies have re-
ported that dermoscopy can improve the accuracy of clinical diagnosis
of skin cancer, especially for melanoma [38].
Reflectance confocal microscopy (RCM) is a non-invasive imaging
technique that allows for in vivo imaging of skin at cellular resolution.
Several studies have shown that RCM can improve the diagnostic
accuracy of skin cancer, especially for difficult-to-diagnose lesions [39].
Artificial intelligence (AI) and machine learning (ML) algorithms
have been increasingly used for the detection and diagnosis of skin
cancer. Several studies have reported high sensitivity and specificity
of AI/ML algorithms for the detection of skin cancer using dermoscopy
and/or RCM images [40].
Kousis and et al. [41] used CNN and get accuracy near about 92%
by using HAM10000 Dataset. In the article author choose the DenseNet
169 CNN. Model is train with less number of images by providing more
images, model can be train.
Mohakud et al. [42] used CNN grey wolf algorithm, the proposed
method achieved a high level of accuracy, it can be used in its current
form or with minor modifications to the algorithm to detect more than
one type of cancer.
The authors of [43] applied four separate CNN models based on
ResNet, SqueezNet, DenseNet, and Inception v3, in that order. They
used the HAM10000 dataset to train and test them, which was sepa-
rated into training (80%), validation (10%), and test (10%) sets. For the
two-class prediction instance, the best model (Inception v3) achieved a
95.74%. Model is train with less number of images by providing more
images, model can be train. Model is train for two classes only.
The authors of [44] created a model for skin disease categorization
that included the MobileNet and LSTM architectures. For training and
evaluation, they used the HAM10000 dataset. The author developed
mobileapp for the same using MobileNet and LTSM.
Oral visual examination is the primary method for the detection of
oral cancer. However, the accuracy of visual examination depends on
the experience and skill of the examiner [45].
Auto fluorescence imaging (AFI) is a non-invasive imaging tech-
nique that uses a special light to highlight abnormal tissue in the
mouth. Several studies have shown that AFI can improve the accuracy
of oral cancer detection [46].
Narrow-band imaging (NBI) is a type of endoscopic imaging that en-
hances the visibility of blood vessels in the mucosa. Several studies have
reported high accuracy of NBI for the detection of oral cancer [47].
AI and ML algorithms have also been used for the detection of
oral cancer using various imaging modalities, such as AFI and NBI.
Several studies have reported high sensitivity and specificity of AI/ML
algorithms for the detection of oral cancer [48] .
‘‘Classification of the clinical images for benign and malignant
cutaneous tumors using a deep learning algorithm’’ by [49] Han et. Al.
The study utilized a deep learning approach for skin cancer diagnosis.
The authors trained a CNN model using 129,450 clinical images of
skin lesions, including benign and malignant melanomas. The model
achieved a sensitivity of 90.0% and specificity of 92.1% in classifying
melanoma versus benign nevi.
‘‘Skin Lesion Analysis Toward Melanoma Detection: A Challenge at
the 2017 International Symposium on Biomedical Imaging’’ by Codella
et al. (2018). The authors present a challenge to develop a CNN-based
model to diagnose skin lesions, particularly melanoma. The challenge
used a dataset of over 2000 dermoscopy images. The top-performing
algorithm achieved an area under the curve (AUC) of 0.86, which
outperformed the performance of 157 dermatologists who participated
in the study [50].
4
Healthcare Analytics 3 (2023) 100199
‘‘Automated Skin Cancer Detection through Spectral-Spatial Feature
Fusion and Deep Learning’’ by Zhang et al. (2019) The study proposed
a novel approach to skin cancer detection that combined spectral and
spatial features with a deep learning model. The authors trained the
model using a dataset of 2000 dermoscopy images and achieved an
AUC of 0.955 for melanoma detection and an AUC of 0.916 for basal
cell carcinoma detection.
‘‘Dermatologist-level classification of skin cancer with deep neu-
ral networks’’ by Esteva et al. (2017) The authors trained a CNN
model using over 130,000 clinical images of skin lesions to classify
images into three categories: benign, malignant, or non-neoplastic. The
model achieved a sensitivity of 95% and specificity of 84%, which
outperformed the performance of 21 board-certified dermatologists
who participated in the study [40].
‘‘A Novel Multi-task Deep Learning Model for Skin Lesion Segmen-
tation and Classification’’ authors proposed a multi-task CNN model for
the simultaneous classification of seven types of skin lesions, including
melanoma, nevus, and basal cell carcinoma. The model was trained
using a dataset of over 10,000 dermoscopy images and achieved an
overall accuracy of 83.6% [51].
In conclusion, CNNs have shown great potential in the detection of
skin cancer and oral cancer from medical images. These studies provide
evidence that CNNs can accurately detect and classify skin cancer and
oral cancer, and can potentially be used as a tool to aid in the early
diagnosis of skin cancer and oral cancer. These studies utilized different
approaches and datasets, but all achieved significant levels of accuracy
in diagnosing skin lesions. The use of CNN models in dermatology has
the potential to improve diagnostic accuracy and reduce unnecessary
biopsies, leading to better patient outcomes.
6. Convolutional Neural Network (CNN)
A Convolutional Neural Network (CNN) is a type of deep learning
neural network that is commonly used for image recognition and
computer vision tasks.
CNNs are designed to recognize patterns in visual data by processing
images through multiple layers of convolutions and pooling operations.
Each layer consists of a set of filters that are convolved with the input
image, producing a set of activation maps that highlight the presence
of certain features in the image. Pooling layers then downsample the
activation maps, reducing the size of the data and capturing the most
salient information [52,53].
CNNs also typically include fully connected layers at the end of
the network, which take the output of the convolutional and pooling
layers and use it to classify the input image into one of several possible
categories.
CNNs have achieved state-of-the-art results on a wide range of
computer vision tasks, including image classification, object detection,
and segmentation. They have also been used in other domains such as
natural language processing and speech recognition.
CNN architecture:
The architecture of a CNN (Convolutional Neural Network) used for
skin cancer diagnostics typically includes convolutional layers, pooling
layers, fully connected layers, and output layers.
The following is a summary of each layer of CNN :
Layers of convolutions: In Fig. 2 it shows to perform the convolution
process on the input image, these layers employ a collection of trainable
filters or kernels. The filters help to extract relevant information from
the input image, such as texture patterns, corners, and edges.
Pooling layers: These layers down sample the output of the convolu-
tional layers by taking the maximum or average value of a group of
pixels. Pooling reduces the spatial scale of the input image, increasing
the model’s resistance to input changes.
D. Raval and J.N. Undavia
Fig. 2. Convolutional neural networks architecture [54].
Fully connected layer: These layers connect every neuron in the
previous layer to every neuron in the layer above. They help with both
prediction and detecting the essential parts in the given image.
Output Layer: The model’s output layers generate the predicted class
of the input image (for example, melanoma, non-melanoma), which is
the model’s ultimate output.
In addition to these layers, some CNN architectures incorporate
dropout, batch normalization, and data augmentation to improve the
model’s performance and generalizability.
All the other CNN model works on the same architecture of the CNN
which shown in Fig. 2.
There are several methods to improve the performance of CNN on
image classification:
• Data Augmentation is the process of creating new training data
from existing data by performing various transformations such as
rotation, scaling, flipping, and noise. Data augmentation can help
improve the size and diversity of the training set, boosting the
model’s capacity to generalize.
• Transfer Learning: Transfer learning entails fine-tuning
pre-trained models that have been learned on big datasets for a
specific goal. This strategy can assist increase CNN performance
with minimal training data while also reducing training time.
• Optimizers: Various optimizers, like as Adam, RMSprop, and SGD,
can be used to update the CNN weights during training. Choosing
the right optimizer can improve the model’s training speed and
convergence rate.
• CNN Architecture Design: The CNN architecture design is critical
in deciding the model’s performance. To increase the model’s
accuracy and save training time, techniques such as depthwise
separable convolution, residual connections, and attention mech-
anisms can be applied.
• Tuning Hyperparameters: Hyperparameters such as learning rate,
batch size, and number of epochs can all have a major impact
on the model’s performance. The accuracy of the model can be
improved by tuning these hyperparameters using strategies such
as grid search or random search.
The subsection part discusses the various Convolutional Neural Net-
works (CNNs).
6.1. AlexNet
AlexNet is a convolutional neural network that was introduced by
Alex Krizhevsky, Ilya Sutskever, and Geoffrey Hinton in 2012. It was
designed to participate in the ImageNet Large Scale Visual Recogni-
tion Challenge (ILSVRC), which is an annual competition that aims
5
Healthcare Analytics 3 (2023) 100199
Fig. 3. AlexNet architecture [56].
to evaluate the performance of computer vision algorithms for image
recognition tasks.
AlexNet consists of eight layers, including five convolutional layers
and three fully connected layers. It was one of the first deep convolu-
tional neural networks to use rectified linear units (ReLU) instead of the
more traditional sigmoid activation function. The use of ReLU allowed
AlexNet to train faster and achieve better performance than previous
networks. Fig. 2 shows the AlexNet architecture [55].
As per Fig. 3 shows each layer of AlexNet performs a specific
operation on the input data, which is typically an image. The input
to the first layer is a 227 × 227 × 3 image (where 227 × 227 is the size
of the image and 3 is the number of color channels), and the output
of the last layer is a vector of probabilities indicating the likelihood of
each of the 1000 possible classes in the ImageNet dataset.
Input Layer:
The input layer of AlexNet takes an RGB image of size 227 × 227
× 3, where 227 × 227 is the spatial size of the image and 3 is the
number of color channels.
Convolutional Layer 1:
The first convolutional layer in AlexNet applies 96 filters of size
11 × 11 × 3 to the input image with a stride of 4 and no padding.
The output of this layer is passed through a ReLU activation func-
tion, which introduces non-linearity into the output. The mathematical
representation of this layer can be written as:
𝐻 1 = 𝑅𝑒𝐿𝑈 (𝑊 1 ∗ 𝑋 + 𝑏1 ) (1)
1
where 𝑋 is input image and 𝑊 set for 96 filters of size 11 × 11 × 3
and 𝑏1 bias term for each filter.
Max Pooling Layer 1:
After the first convolutional layer, a max pooling layer is applied to
the output with a filter size of 3 × 3 and a stride of 2. The mathematical
representation of this layer is:
P1ijk = max(𝑍2𝑖−1
1
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
) (2)
Convolutional Layer 2:
The second convolutional layer in AlexNet applies 256 filters of size
5 × 5 × 48 to the output of the first max pooling layer with a stride of
1 and padding of 2. The output of this layer is passed through a ReLU
activation function. The mathematical representation of this layer can
be written as:
𝐻 3 = 𝑅𝑒𝐿𝑈 (𝑊 2 ∗ 𝐻 2 + 𝑏2 ) (3)
where 𝑊 2 set for 256 filters of size 5 × 5 × 48 and 𝑏2 bias term for
each filter.
Similar to the first max pooling layer, a second max pooling layer
is applied to the output of the second convolutional layer with a filter
D. Raval and J.N. Undavia
size of 3 × 3 and a stride of 2. The mathematical representation of this
layer is the same as that of max pooling layer 1.
P2ijk = max(𝑍2𝑖−1
2
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
) (4)
Convolutional Layer 3:
The third convolutional layer in AlexNet applies 384 filters of size
3 × 3 × 256 to the output of the second max pooling layer with a stride
of 1 and a padding of 1.
𝐻 4 = 𝑅𝑒𝐿𝑈 (𝑊 3 ∗ 𝐻 3 + 𝑏3 )
where 𝑊 3 set for 384 filters of size 3 × 3 × 256 and 𝑏3 bias term for
each filter.
The third layer of AlexNet is a max pooling layer with a pool size
of 3 × 3 and a stride of 2. Let us denote the output feature map of
the third convolutional layer as 𝑍 3 and the output feature map of the
third pooling layer as 𝑃 3 . Then, the output of the third pooling layer
is obtained by taking the maximum value over each non-overlapping
3 × 3 region of the third convolutional layer. This can be represented
mathematically as:
3 3
𝑃𝑖𝑗𝑘 = max(𝑍2𝑖−1 ∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
) (6)
3
where 𝑃𝑖,𝑗,𝑘 is the (i,j,k)th element of the output feature map of the
3
third pooling layer, (𝑍2𝑖−1 ) is the 3 × 3 region of the 𝑘th
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
channel of the third convolutional layer centered at (2i, 2j), and max()
takes the maximum value over the elements of the 3 × 3 region.
Convolutional Layer 4
The fourth convolutional layer of AlexNet has 384 filters, each with
a size of 3 × 3 × 192. The convolution operation is performed with a
stride of 1 and zero-padding of size 1.
𝐻 5 = 𝑅𝑒𝐿𝑢(𝑊 4 ∗ 𝐻 4 + 𝑏4 )
The fourth layer of AlexNet is also a max pooling layer with a pool
size of 3 × 3 and a stride of 2. Let us denote the output feature map of
the fourth convolutional layer as 𝑍 4 and the output feature map of the
fourth pooling layer as 𝑃 4 . Then, the output of the fourth pooling layer
is obtained by taking the maximum value over each non-overlapping
3 × 3 region of the fourth convolutional layer. This can be represented
mathematically as:
4 4
𝑃𝑖𝑗𝑘 = max(𝑍2𝑖−1 ) (8)
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
where 4
𝑃𝑖𝑗𝑘is the (i,j,k)th element of the output feature map of the
fourth pooling layer, 𝑍2𝑖−14 is the 3 × 3 region of the
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
𝑘th channel of the fourth convolutional layer centered at (2i, 2j), and
max() takes the maximum value over the elements of the 3 × 3 region.
Convolutional Layer 5
The fifth convolutional layer of AlexNet has 256 filters, each with
a size of 3 × 3 × 192. The convolution operation is performed with a
stride of 1 and zero-padding of size 1 on the output feature map of the
fourth layer.
𝐻 6 = 𝑅𝑒𝐿𝑈 (𝑊 5 ∗ 𝐻 5 + 𝑏5 )
After the fifth convolutional layer, AlexNet applies max pooling
with a stride of 2 and a filter size of 3 × 3 on the output feature map.
Let us denote the output feature map of the fifth convolutional layer
as 𝐻 6 and the output feature map after max pooling Then, the max
pooling operation is defined as follows:
p5ijk = max(𝑍2𝑖−1
5
) (10)
∶ 2𝑖+1,2𝑗−1 ∶ 2𝑗+1,𝑘
AlexNet uses three fully connected layers, also known as dense
layers. The output of the last max pooling layer is flattened into a
vector and fed into the first fully connected layer. Here’s the detail with
equations:
Flattening Layer:
Healthcare Analytics 3 (2023) 100199
Fig. 4. VGGNet architecture [57].
The output feature map of the last max pooling layer is a 6 × 6 × 256
(5) tensor. To pass it into the fully connected layers, it needs to be flattened
into a 1D vector. This can be done using the reshape function:
𝐹 = 𝑟𝑒𝑠ℎ𝑎𝑝𝑒(𝑃 5 , [1, 66256]) (11)
where F is the flattened feature vector, 𝑃 5 is the output feature map of
the fourth max pooling layer, and reshape() converts the 6 × 6 × 256
tensor into a 1D vector of size 1 × (66256).
Fully Connected Layer 1:
The first fully connected layer of AlexNet has 4096 neurons. It
takes the flattened feature vector 𝐹 as input and applies a matrix
multiplication with a weight matrix 𝑊 5 of size 9216 × 4096, followed
by an element-wise addition of a bias vector 𝑏5 of size 1 × 4096. The
output is passed through the ReLU activation function:
𝐻 6 = 𝑓 (𝑊 5 ∗ 𝐹 + 𝑏5 ) (12)
where 𝐻 6 is the output of the first fully connected layer, 𝑓 () is the ReLU
activation function, * represents the matrix multiplication operation,
and + represents the element-wise addition operation.
Fully Connected Layer 2:
The second fully connected layer of AlexNet also has 4096 neurons.
It takes the output of the first fully connected layer 𝐻 6 as input and
(7) applies a matrix multiplication with a weight matrix 𝑊 6 of s4ize
4096 × 4096, followed by an element-wise addition of a bias vector
𝑏6 of size 1 × 4096. The output is passed through the ReLU activation
function:
𝐻 7 = 𝑓 (𝑊 6 ∗ 𝐻 6 + 𝑏6 ) (13)
where 𝐻 7 is the output of the second fully connected layer.
Fully Connected Layer 3:
The final fully connected layer of AlexNet has 1000 neurons, cor-
responding to the 1000 classes in the ImageNet dataset. It takes the
output of the second fully connected layer 𝐻 7 as input and applies a
matrix multiplication with a weight matrix 𝑊 7 of size 4096 × 1000,
followed by an element-wise addition of a bias vector 𝐵 7 of size
1 × 1000. The output is passed through the softmax activation function:
𝑌 = 𝑠𝑜𝑓 𝑡𝑚𝑎𝑥(𝑊 7 ∗ 𝐻 7 + 𝑏7 ) (14)
where 𝑌 is the output of the final fully connected layer, which repre-
sents the predicted probabilities of the input image belonging to each
of the 1000 classes in the dataset. The softmax function normalizes the
output into a probability distribution over the classes.x
(9)
6.2. VGGNet
VGGNet is a deep convolutional neural network architecture pro-
posed by Karen Simonyan and Andrew Zisserman in 2014. It was
designed to improve the performance of convolutional neural net-
works (CNNs) on image classification tasks by using smaller filter
sizes and deeper network structures. In this answer, we will explain
VGGNet in detail, including the mathematical equations involved in its
architecture.
VGGNet consists of 19 layers (excluding the input layer) can see in
Fig. 4 and is composed of a series of convolutional layers, followed by
pooling layers, and then fully connected layers. The architecture can
be summarized as follows:.
6
D. Raval and J.N. Undavia
As per Fig. 4 Input (224 × 224 × 3) → Convolutional Layers →
Pooling Layers → Fully Connected Layers → Output (1000 classes)
The first layer in the network is an input layer, which takes an RGB
image of size 224 × 224 × 3. The input is then passed through a series
of convolutional layers, where each layer applies a set of learnable
filters to the input. The output of each convolutional layer is then
passed through a rectified linear unit (ReLU) activation function, which
introduces non-linearity into the network.
After several convolutional layers, the output is passed through
pooling layers, which reduce the size of the feature maps and introduce
some level of translation invariance. VGGNet uses max pooling, where
the maximum value within a pool of neurons is taken as the output.
Finally, the output of the last pooling layer is passed through fully
connected layers, which perform the final classification. The output of
the network is a softmax function over the 1000 classes in the ImageNet
dataset.
Convolutional Layers:
VGGNet uses convolutional layers with small 3 × 3 filters, which
have been shown to be more effective than larger filters. Each convo-
lutional layer applies a set of learnable filters to the input and produces
an output feature map. The output feature map has the same depth as
the number of filters used in the layer. The size of the output feature
map is determined by the following equation:
output_size = (input_size − filter_size + 2 ∗ padding)∕stride + 1
where input_size is the size of the input feature map, filter_size is the
size of the filter, padding is the number of zero padding pixels added
to the border of the input feature map, and stride is the stride used to
move the filter over the input feature map.
6.3. Inception
The Inception architecture was introduced by C szegedy et al. in
2014 and is distinguished by the application of numerous parallel
convolutional layers with various filter size []. This allows the network
to capture features at multiple scales and resolutions. Before sending
the feature maps to the following layer, the Inception design also
performs 1 × 1 convolutions to minimize their dimensionality.
In a traditional CNN architecture, a single filter size is used at each
layer to capture local features. In contrast, Inception uses a combination
of filters with different sizes to capture features at different scales.
This is achieved by using a combination of 1 × 1, 3 × 3, and 5 × 5
convolutions in parallel, as well as a pooling operation. The output of
each operation is concatenated and passed on to the next layer.
Mathematically, let us assume that an input feature map X and we
want to apply a set of filters {W1 , 𝑊2 , . . . , 𝑊n } with different sizes to
capture features at different scales. In a traditional CNN, apply each
filter separately to the input feature map:
𝑌𝑖 = 𝑓𝑖 (𝑋; 𝑊𝑖 ) (15)
where 𝑓𝑖 is a non-linear activation function and 𝑌𝑖 is the output feature
map produced by filter 𝑊𝑖 .
In Inception, we apply a set of filters with different sizes in parallel
and concatenate their outputs:
( )
𝑌 = 𝑐𝑜𝑛𝑐𝑎𝑡(𝑓𝑖 𝑋; 𝑊𝑖 ) (16)
where ‘‘concat’’ denotes the concatenation operation and 𝑓𝑖 is a non-
linear activation function.
In addition to the parallel filter sizes, Inception also includes 1 × 1
convolutions, which can be used to reduce the number of input chan-
nels and the computational cost of the network. These are known as
bottleneck layers and are used to reduce the number of input channels
before applying the more expensive 3 × 3 and 5 × 5 convolutions.
The output of each Inception module is then passed through a
pooling layer, which can be used to down sample the feature map and
capture global features.
7
Healthcare Analytics 3 (2023) 100199
Fig. 5. Residual block [60].
Fig. 6. Demonstrates the block of DenseNet [60].
In summary, Inception is a deep learning architecture that uses a
combination of filters with different sizes in parallel to capture features
at different scales. This allows the network to capture both local and
global features and can improve the performance of the model. The
use of 1 × 1 convolutions and pooling layers also helps to reduce the
computational cost of the network.
6.4. ResNet
Residual Network (ResNet) is a type of deep neural network that has
been widely used in computer vision tasks such as image recognition,
object detection, and segmentation. ResNet was introduced by Kaiming
He et al. in their paper ‘‘Deep Residual Learning for Image Recognition’’
in 2016 [58,59]
A ResNet layer consists of two main components: the identity short-
cut connection and the residual block. It is shown in Fig. 5.
Residual Network (ResNet) is a type of deep neural network that has
been widely used in computer vision tasks such as image recognition,
object detection, and segmentation. ResNet was introduced by Kaiming
He et al. in their paper ‘‘Deep Residual Learning for Image Recognition’’
in 2016 [8].
A ResNet layer consists of two main components: the identity short-
cut connection and the residual block. It is shown in Fig. 5.
In summary, a ResNet layer takes an input 𝑥, applies a series of
convolutional layers with batch normalization and activation functions
to obtain 𝐹 (𝑥), adds an identity shortcut connection to preserve the
information from the input, and finally adds the output of the convolu-
tional layers and the identity shortcut connection to obtain the output
of the layer.
6.5. DenseNet
Dense Convolutional Network (DenseNet) is a deep learning archi-
tecture that was introduced in 2017 by researchers at Facebook AI
Research. DenseNet is based on the idea of dense connections, which
allow feature maps to be reused and combined in a highly efficient
manner.
In a traditional CNN architecture, each layer takes the output of the
previous layer as its input. In contrast, DenseNet layers take as input
the concatenation of all previous feature maps. This is known as a dense
block and it allows each layer to receive direct input from all previous
layers.
Mathematically, let us assume a set of feature maps {𝑋0 , 𝑋1 , … ,
𝑋𝐾−1 } that need to combine into a new set of feature maps 𝑋𝐾 . A typ-
[ ]
ical convolutional layer would compute 𝑋𝑘 − 𝑓𝑘 ( 𝑋0 , 𝑋1 , … , 𝑋𝐾−1 𝜃k )
[ ]
where 𝑋0 , 𝑋1 , … , 𝑋𝐾−1 is the concatenation of all previous feature
maps and 𝑓𝑘 is a function parameterized by 𝜃k as per Fig. 6.
D. Raval and J.N. Undavia
Fig. 7. DenseNet architecture [60].
In a dense block, however, the output feature maps are computed
as follows as per Fig. 7. and equation,
𝑋𝑘 = 𝐻𝑘 (𝑋0 , 𝑋1 , … , 𝑋𝑘−1 ) (17)
where 𝐻𝑘 is a set of non-linear transformations that are applied to the
concatenation of all previous feature maps.
In other words, the output feature maps of each layer in a dense
block are the concatenation of all previous feature maps and the output
of the non-linear transformation applied to them.
This allows feature maps to be reused and combined in a highly
efficient manner, since each layer has access to all the previous feature
maps. This also leads to a significant reduction in the number of
parameters in the network, since each layer only needs to learn a small
number of additional filters.
DenseNet architectures typically consist of a series of dense blocks,
with each block followed by a transition layer that reduces the number
of feature maps by using a 1 × 1 convolution and a pooling layer. The
last layer of the network is a fully connected layer that outputs the class
probabilities.
6.6. GNN
Graph Neural Networks (GNNs) are a type of neural network that
can model and analyze graph-structured data. They have become in-
creasingly popular in recent years due to their ability to represent
and process complex relationships between entities, such as molecules,
social networks, and biological networks, among others.
Advantages of GNN are ‘‘Ability to model graph-structured data’’,
‘‘Ability to capture complex relationships’’, ‘‘Ability to handle variable
input size’’ and, ‘‘Ability to integrate multiple data modalities’’.
Potential for transfer learning: GNNs can be trained on one graph
and transferred to another graph with similar structure, enabling them
to be used in different contexts or domains
GNN with all the math in depth, we will start by introducing some
notation. Let us assume that we have a graph 𝐺 = (𝑉 , 𝐸), where V is
the set of nodes and E is the set of edges. Each node i ∈ V has a feature
vector 𝑥i ∈ Rd, and each edge (i, j) ∈ E has a weight 𝑤ij .
The goal of a GNN is to learn a representation hi ∈ Rh for each
node i, which captures both its own features and the features of its
neighboring nodes. The key idea behind a GNN is to define a message
passing scheme, which allows nodes to aggregate information from
their neighbors and update their own representations [61].
One common message passing scheme is the Graph Convolutional
Network (GCN), which can be defined as follows:
ℎ𝑖 = 𝜎(𝛴𝑗𝜖𝑁𝑖 𝑤𝑖𝑗.ℎ𝑗.𝑊 ) (18)
where N(i) is the set of neighboring nodes of node i, W is a learn-
able weight matrix, and 𝜎(⋅) is an activation function. In this equa-
∑
tion, the term j∈N(i) wij ⋅ hj represents the aggregated information
from the neighbors of node i, which is then combined with its own
representation hi through a linear transformation W.
The above equation can be rewritten as (see Fig. 8):
ℎ𝑖 = 𝜎(𝑊 .𝛴𝑗𝜖𝑁 𝑖𝑤𝑖𝑗.ℎ𝑗.𝑊 ) (19)
This form shows that the GCN is simply a linear transformation of
the aggregated neighbor features, followed by an activation function.
8
Healthcare Analytics 3 (2023) 100199
Fig. 8. Demonstrates the architecture of GNN [62].
Another message passing scheme that has gained popularity in
recent years is the Graph Attention Network (GAT), which uses an
attention mechanism to selectively attend to important neighbors. The
GAT can be defined as follows:
𝑒𝑖𝑗 = 𝛼 (𝑥𝑖, 𝑥𝑗) = 𝑆𝑜𝑓 𝑡𝑚𝑎𝑥(𝐿𝑒𝑎𝑘𝑦𝑅𝑒𝐿𝑈 (𝑎𝑇 [𝑊 𝑥𝑖 ∥ 𝑊 𝑥𝑗])) (20)
where 𝛼(xi, xj) is the attention weight between node i and node j, Leaky
ReLU is a non-linear activation function, a and W are learnable weight
matrices, and ∥ denotes concatenation. The attention weight 𝛼(xi, xj)
is computed as a function of the feature vectors xi and xj, and the
weight matrices a and W. The softmax function normalizes the attention
weights, ensuring that they sum to one.
The above equations show how a GNN can be used to learn node
representations that capture both the local and global structure of the
graph. By aggregating information from neighbors and updating node
representations, a GNN can learn complex relationships between nodes
in the graph, making it a powerful tool for a wide range of applications.
The GNN will used for oral cancer as dataset for oral cancer is less in
compare to the dataset available for skin cancer.
The following summarized steps to implement GNN :
• The initial step in developing GNNs is to represent the input data
as a graph. A graph is described as a collection of nodes and edges,
where nodes represent entities and edges reflect relationships
between them. Nodes in GNNs can represent any form of object,
such as social network users, atoms in a chemical, or words in a
paper.
• Node characteristics: Each node in the graph has a feature vector
that describes its qualities or characteristics. These characteristics
might be obtained from the traits of the entity represented by the
node or learned from the data.
• Message passing: Message passing between nodes is the primary
operation in GNNs. Message passing involves the exchange of
information between nodes in a graph in order to update their
representations. The message sent from node i to node j is deter-
mined by the characteristics of node i and the edge between i and
j. This message is then utilized to update node j’s representation.
• Aggregation occurs when the message has been transmitted from
node i to all of its neighboring nodes j, and these messages are
aggregated to construct a new representation for node i. Any
function that takes in a set of vectors and returns a single vector
can be used as the aggregation function. Summation is a common
aggregating function in which messages are simply added up.
D. Raval and J.N. Undavia
• After the updated node representations have been computed, they
are passed through one or more neural network layers to generate
the final output. These neural network layers might be of any sort,
such as fully connected layers or convolutional layers.
• The final output of the GNN is determined by the task being
performed. In node classification, for example, the GNN is trained
to predict a node’s label based on its features and the features
of its neighbors. The GNN is trained in graph classification to
predict the label of an entire graph based on its structure and
node attributes.
7. Dataset
A dataset is a collection of data that is used to train, validate, and
test machine learning models. It is a critical component of any machine
learning, as the quality and quantity of the data can have a significant
impact on the performance of the model. A good dataset should be
large, diverse, balanced, and free from errors and biases. It should also
be annotated with labels or annotations that provide the ground truth
for the problem being solved. Access to high-quality datasets is essential
for advancing the field of machine learning, as it allows researchers
and developers to test and improve their models on a wide range of
problems and applications.
One popular skin cancer dataset is the International Skin Imag-
ing Collaboration (ISIC) dataset, which contains over 25,000 clinical
images of skin lesions, including malignant melanoma, nevi, and seb-
orrheic keratosis. The images were collected from 17 different sources,
including clinical settings, dermoscopy devices, and consumer-grade
cameras. The dataset also includes additional metadata, such as patient
age, sex, and diagnosis [63–65].
Another skin cancer dataset is the HAM10000 dataset, which con-
tains over 10,000 images of skin lesions. The dataset includes seven dif-
ferent types of skin lesions, including melanoma, nevus, and basal cell
carcinoma. The images were collected from a variety of sources, includ-
ing clinical settings and consumer-grade cameras, and were manually
annotated by dermatologists. HAM10000 is subset of ISIC [65].
The PAD-UFES-20 dataset was collected in conjunction with the
Dermatological and Surgical Assistance Program (PAD) at the Federal
University of Espírito Santo (UFES) in Brazil. The dataset consists of
2298 samples of six different types of skin lesions, including Basal Cell
Carcinoma (BCC), Squamous Cell Carcinoma (SCC), Actinic Keratosis
(ACK), Seborrheic Keratosis (SEK), Bowen’s disease (BOD), Melanoma
(MEL), and Nevus (NEV) [66].
There are 170 images in the MED-NODE dataset, of which 100 nevus
and 70 melanomas.
A dataset for histopathologic oral cancer detection using CNNs
(HOCD) is containing a total of 5192 histopathologic images of oral
lesions, including 2494 benign lesions and 2698 malignant lesions.
8. Preprocessing
This article applies CNN machine learning to a dataset of skin
lesions. There must be some data preprocessing done on the data before
using CNN for that purpose.
Image resizing: This technique involves resizing all the images in the
dataset to a standard size. This can help in reducing the size of the
dataset, making it easier to work with, and reducing the time taken for
training the model.
Image normalization: Normalization involves adjusting the pixel val-
ues of the images so that they have a common scale. This can help
in improving the performance of the model as it makes it easier to
compare images.
Image augmentation: This technique involves generating new im-
ages from the existing ones by applying transformations such as rota-
tion, scaling, and flipping. This can help in increasing the size of the
9
Healthcare Analytics 3 (2023) 100199
dataset and making it more diverse, which can help in improving the
performance of the model.
Image filtering: Filtering involves applying filters such as Gaussian,
Median, or Sobel filters to the images. This can help in removing noise
from the images and making them clearer, which can improve the
accuracy of the model.
Image segmentation: Segmentation involves dividing the image into
smaller parts based on certain features such as color or texture. This
can help in identifying specific areas of interest in the image, which
can be useful for diagnosis or treatment of skin cancer.
Feature extraction: Feature extraction involves extracting relevant
features from the images such as color, texture, and shape. These
features can then be used as inputs to the model for classification or
detection of skin cancer.
Preprocessing technique applied on dataset:
1. Image resize: In deep learning, images are typically represented
as matrices of pixel values. Larger images require more memory
to store and process, which can become a bottleneck when work-
ing with limited computational resources. Resizing an image to
a smaller size reduces the memory footprint, making it easier to
work with.
2. Image Augmentation to Increased training data, In deep learn-
ing, the performance of the model is often limited by the size
and quality of the training dataset. By augmenting the dataset,
we can increase the amount of data available for training, which
can lead to better performance and reduce the overfitting. Some
common image augmentation techniques include:
a. Rotation: the process of rotating an image by a specific
angle to produce new versions of the original image.
b. Flip and mirror: flipping or mirroring an image horizon-
tally or vertically to produce new versions.
c. Scaling and cropping: scaling an image or cropping a
piece of it to produce new versions.
d. Shifting an image horizontally or vertically to create new
versions.
e. Adding noise: Adding random noise to an image to pro-
duce new versions.
f. Changing the brightness and contrast of an image to
produce new variations.
g. Shearing is the process of altering an image along a
specified axis to create new variations.
h. Gaussian blur: applying a Gaussian blur to an image to
generate fresh variations.
Rotation on images used to enhance the size of the training
dataset from the above-mentioned technique.
3. Image filtering: Image filtering technique used to remove noise
from images like hair. Hair removal in digital photos can be
accomplished using a variety of image processing techniques.
Here are a few examples of common techniques:
a. Median filtering is a technique for removing tiny hair-like
features from images. Each pixel in the image is replaced
by the median value of the neighboring pixels in median
filtering. This aids in the smoothing of the image and the
removal of tiny hair-like formations.
b. Thresholding: This technique is used to remove hair that
is darker or lighter than the image’s surrounding ar-
eas. Thresholding involves selecting a threshold value
and replacing any pixels with values that are greater
or lower than the threshold with values that match the
surrounding pixels.
D. Raval and J.N. Undavia Healthcare Analytics 3 (2023) 100199

Table 3 Table 6
Insights of skin dataset. Hyper parameters for network training.
Skin deformity class ISIC PDA Batch size 32
No of data No of data Epochs 20
Learning rate 0.0001
Actinic keratosis 867 730
Activation function ReLU
Basal Cell Carcinoma 3323 845
Optimizer Adam
Benign keratosis 2624 –
Loss function Binary cross entropy
Dermatofibroma 239 –
Melanoma 4522 52
Melanocytic Nevus 12 900 244
Squamous cell carcinoma 628 192
Vascular lesion 253 – Table 7
Total 25 356 2063 Hardware and tools used for network training.
IDE Google Colab Pro
Processor TPU (Tensor Processing Unit)
Version: Python 3 Google Computer Engine
Table 4
Insights of oral dataset. RAM 36 GB
APIs/Libraries Python 3, Tensorflow, Keras, Matplot
Oral lesions class HOCD
No of data
Oral Squamous cell carcinoma 2698
Non-Cancerous 2494 9. Experiment and result
Total 5192

The quality and quantity of skin cancer data used to train the model
can have a significant impact on its performance. It is critical to have
a big number of high-quality data that is diverse and representative of
Table 5
Insights of Skin dataset. the various types of skin cancers and skin types in order to construct
Study Train Validation Test Total
an accurate and reliable model.
Actinic keratosis 1180 320 97 1597 Quality of data: The precision and dependability of data are referred
Basal cell carcinoma 2918 833 417 4168 to as data quality. When it comes to skin cancer, data quality is
Benign keratosis 1837 525 262 2624
vital because the right diagnosis is critical for determining the tumor’s
Dermatofibroma 167 48 24 239
Melanoma 3200 915 459 4574 aggressiveness and the appropriate course of treatment. If the data used
Melanocytic Nevus 9200 2628 1316 13 144 to train the model is inaccurate, the model’s performance may suffer,
Squamous cell carcinoma 574 164 82 820 leading to misdiagnosis or incorrect predictions.
Vascular lesion 177 51 25 253
Total 19 253 5484 2682 27 419 Quantity of data: the amount of data utilized to train the model is
referred to as data quantity. In the case of skin cancer, more data will
almost certainly increase the model’s performance. A model that has
only been trained on a short sample size is likely to be less accurate
c. Image inpainting is a technique for filling in missing or and to suffer from overfitting, which occurs when the model becomes
damaged sections of an image. Image inpainting can be
overly preoccupied with the training data and struggles to generalize
used in hair removal to fill in regions where hair has been
to new data.
removed, resulting in a continuous image.
The following steps are involved in training a Convolutional Neural
d. Edge detection is a technique for identifying the edges of
Network (CNN) for skin cancer detection:
objects in a picture. Edge detection can be used in hair
removal to identify the edges of hair and separate them • Data Collection: Gather images of skin cancer from ISIC and PDA
from the surrounding portions of the image. to create a dataset [63,64,66] . It is critical that the dataset
e. The Fourier Transform can be used to remove periodic have a balanced distribution of all kinds of skin cancer. This
noise or repeating patterns in an image. It can also be is significant because an uneven dataset can induce bias in the
used to detect and remove undesirable frequencies from model’s predictions.
an image, such as hair formations. • Data Preprocessing: Prepare the dataset by shrinking images to
f. Morphological operations: You can use this technique to consistent sizes, converting them to grayscale or RGB, and nor-
remove little hair-like structures from an image. Morpho- malizing pixel values to be between 0 and 1.
logical procedures that change the shape and size of the
• Dataset Splitting: Divide the dataset into training, validation, and
objects in the image include dilatation, erosion, opening,
testing sets. A typical ratio is 70% training, 20% validation, and
and closing.
15% testing.
Most effective techniques for removing noise from image are Image • Build a model: Create the CNN architecture with frameworks like
thresholding can be used to remove hair structures that are darker or Keras, PyTorch, or TensorFlow. Begin with a minimal design and
lighter than the surrounding skin, whilst morphological techniques can progressively add complexity as needed.
be used to remove minuscule hair-like structures. • Train the model: optimization algorithms, train the model on
Overall, these preprocessing techniques can help in improving the the training set. During training, the model learns to recognize
accuracy and performance of models trained on skin cancer image patterns in images and detect them as skin cancer.
datasets.
The dataset used in this study includes a variety of skin anomalies. AlexNet, VGGNet, ResNet and DenseNet models were implemented us-
As a result, as indicated in Table 4, the dataset comprises of 27 419 ing Tensor Flow and the Keras library in such a way that loss is min-
normal and 9562 malignant (see Table 5). imized and precision is optimized for each epoch paradigm. This con-
In this article, all the experiment will carry out on skin cancer. As figuration of hyperparameter is illustrated in Table 6 The experiment’s
per the detail mentioned in Table 3 there are very less number of data hardware and tools are listed in Table 7. AlexNet, VGGNet, ResNet,
of oral cancer. and DenseNet are compared in Table 7 for training accuracy, validation

10
D. Raval and J.N. Undavia Healthcare Analytics 3 (2023) 100199

Table 8
Comparative study for AlexNet, VGGNet, ResNet and DenseNet.
CNN Alexnet VGGNet ResNet DenseNet
Epoch TA VA TL VL TA VA TL VL TA VA TL VL TA VA TL VL
1. 0.3738 0.3623 0.7116 0.7212 0.3218 0.2874 0.6575 0.6963 0.4715 0.4419 0.8081 1.1546 0.6572 0.5556 0.5274 0.9167
2. 0.4485 0.402 0.6836 0.6703 0.5671 0.5096 0.6333 0.6632 0.5873 0.4546 0.5984 0.8853 0.7579 0.5868 0.4665 0.7817
3. 0.4889 0.4496 0.6895 0.6751 0.5894 0.5485 0.5712 0.6082 0.6817 0.564 0.5965 0.737 0.7642 0.5951 0.3943 0.6295
4. 0.4922 0.4759 0.6839 0.6721 0.6098 0.5732 0.5527 0.6098 0.7085 0.5796 0.5933 0.7087 0.7964 0.6149 0.3562 0.5052
5. 0.5011 0.4954 0.6474 0.6632 0.6753 0.5707 0.4887 0.5547 0.7096 0.6071 0.588 0.6916 0.8053 0.6362 0.3476 0.4539
6. 0.5048 0.4933 0.6434 0.6598 0.7067 0.6895 0.4779 0.5083 0.7128 0.6136 0.5781 0.6849 0.8259 0.6403 0.3358 0.4096
7. 0.5089 0.5017 0.6358 0.6412 0.7398 0.7041 0.4752 0.5272 0.7144 0.6249 0.5729 0.6823 0.8474 0.6595 0.3261 0.3739
8. 0.5124 0.5065 0.6114 0.6385 0.7411 0.7148 0.4686 0.5291 0.7286 0.6585 0.5647 0.6492 0.8551 0.6734 0.3197 0.3638
9. 0.5176 0.5165 0.5947 0.6111 0.742 0.7229 0.4661 0.5543 0.7384 0.6676 0.5579 0.6581 0.8674 0.7037 0.3127 0.3581
10. 0.5199 0.5172 0.5373 0.5889 0.7444 0.7279 0.4463 0.5501 0.7436 0.6833 0.5467 0.641 0.8702 0.7613 0.3059 0.3474
11. 0.5222 0.5175 0.5395 0.5556 0.7457 0.7297 0.4471 0.5224 0.7643 0.6887 0.5263 0.6379 0.8839 0.7863 0.2948 0.3319
12. 0.5271 0.5222 0.5363 0.5442 0.7486 0.7311 0.4285 0.5151 0.7711 0.6913 0.5151 0.621 0.8895 0.7961 0.2868 0.3074
13. 0.5298 0.5212 0.5311 0.5464 0.7519 0.7381 0.3722 0.4871 0.7753 0.6961 0.5083 0.6136 0.8932 0.8073 0.2641 0.2948
14. 0.5342 0.5298 0.5214 0.5281 0.7532 0.7455 0.3817 0.4763 0.7888 0.7065 0.4715 0.6091 0.9039 0.8353 0.2475 0.2726
15. 0.538 0.5301 0.4888 0.5176 0.7549 0.7509 0.3587 0.4614 0.7976 0.7188 0.4557 0.5876 0.9044 0.8452 0.2331 0.2631
16. 0.5409 0.5371 0.4722 0.5186 0.76 0.7524 0.3368 0.4527 0.8061 0.7385 0.4173 0.5561 0.9101 0.8598 0.2277 0.2569
17. 0.5428 0.5399 0.4647 0.4615 0.7636 0.7549 0.3334 0.4071 0.8256 0.7431 0.4057 0.5278 0.9137 0.8784 0.2156 0.2482
18. 0.5458 0.5416 0.4523 0.4593 0.7677 0.7565 0.3214 0.3541 0.8556 0.7473 0.3569 0.5021 0.9172 0.8961 0.2078 0.2263
19. 0.5488 0.5427 0.4447 0.4434 0.7726 0.7577 0.3055 0.3201 0.8647 0.7499 0.3319 0.4831 0.9233 0.9009 0.1932 0.2097
20. 0.5533 0.5401 0.4301 0.4489 0.7734 0.7601 0.3011 0.3187 0.8788 0.7519 0.3261 0.4695 0.9285 0.9047 0.1871 0.2011

Fig. 9. VGGNet and AlexNet model convergence.

accuracy, training loss, and validation loss. The convergence of each
model is depicted in Figs. 9 and 10. It is evident that DenseNet out-
performs ResNet, VGGNet and AlexNet in terms of results. Experiment
carried out on only skin cancer dataset as dataset of oral cancer is not
sufficient (see Table 8).
10. Conclusion
A dataset of skin cancer medical images was collected and analyzed
in this study to train multiple CNN models, including AlexNet, VGGNet,
ResNet, and DenseNet. The performance of these models was compared
using training accuracy, training loss, validation accuracy, and valida-
tion loss. In terms of accuracy and loss, the results indicate that the
DenseNet model beat the other CNN models. These discoveries could
have a significant impact on the development of skin cancer detection
and diagnosis technologies.
11. Future aspects of proposed research
First to prepare for oral cancer medical images and then to check
the performance of the GNN model on the oral cancer images.
Declaration of competing interest
The authors declare that they have no conflicts of interest to report.
This research received no specific grant from any funding agency in the
public, commercial, or not-for-profit sectors.
The research presented in this article has been conducted indepen-
dently, and the authors have made every effort to present unbiased
findings.
Data availability
Data will be made available on request.

11
D. Raval and J.N. Undavia
Fig. 10. ResNet and DenseNet model convergence.
References
[1] G.-M.M.Á. Aguilar-Ruiz, P. Ramos-García, Challenges in the early diagnosis of
oral cancer, evidence gaps and strategies for improvement: A scoping review of
systematic reviews, MDPI Cancer (2022) 1–30.
[2] Skin cancer statistics, https://www.wcrf.org/cancer-trends/skin-cancer-statistics.
[3] Sonal Tina Lal, Raja Paramjeet Singh Banipal, Deepak John Bhatti, Y.H. Prasad,
Changing trends of skin cancer: A tertiary care hospital study in Malwa region
of Punjab, J. Clin. Dign. Res. 10 (6) (2016).
[4] Clinicopathological Profile of Cancers in India:A Report of the Hospital Based
Cancer Registries, 2021, ICMR, Delhi, 2021.
[5] Skin Cancer (Non-Melanoma): Risk Factors and Prevention, Cancer.NET, 2022.
[6] D. Piyu, N. Parth, Munaf, Basal cell carcinoma: A narrative review on
contemporary diagnosis and management, Oncol. Therapy 10 (2022) 317–335.
[7] S.R. Christensen, K.G. Lewis, K.G. ewis, American Cancer Society. Facts & Figures
2023, American Cancer Society, Atlanta, Ga., 2023.
[8] P. Fontanillas, B. Alipanahi, N.e.a. Furlotte, Disease risk scores for skin cancers,
Nature 160 (2021).
[9] D. Z, et al., A multi-task convolutional neural network for skin lesion
classification, diagnosis and segmentation, Pattern Recognit. 107 (2020) 107419.
[10] M.J. Lynn, What are the different types of skin cancer? 2023, [Online].
Available: https://www.everydayhealth.com/skin-cancer/what-are-the-different-
types-of-skin-cancer/. [Accessed March 2023].
[11] R.B. Aldridge, M. Zanotto, L. Ballerini, R.B. Fisher, J. Rees, Novice identification
of melanoma: not quite as straightforward as the ABCDs, Acta Derm. Venereol.
(2011) 125–130.
[12] Hywel C. Williams, FRCP DSc, Strengths and limitations of evidence-based
dermatology, Indian J. Dermatol. 59 (2) (2014) 127–133.
[13] P. Tschandl, N. Codella, B.N. Akay, G. Argenziano, R.P. Braun, H. Cabo, D.
G, Comparison of the accuracy of human readers versus machine-learning
algorithms for pigmented skin lesion classification: An open, web-based,
international, diagnostic study, Lancet Oncol. 20 (7) (2019) 938–947.
[14] C. Watters, S. Brar, T. Pepper, Oral mucosa cancer, in: StatPearls [Internet],
2022.
[15] L. Alzubaidi, H. Hassan, R. S, Onvolutional neural network for classification of
oral cancer images, Int. J. Adv. Comput. Sci. Appl. 11 (7) (2020) 241–247.
[16] Y. Wang, P.J.X. Zhang, X. Li, X. L, Deep learning for oral cancer detection and
diagnosis: A review, Front. Oncol. 9 (2019) 1510.
[17] V. Borse, A.N. Konwar, P. B, Oral cancer diagnosis and perspectives in India,
Sens. Int. (2020).
[18] Shriniket Dixit, A. Anant Kumar, K. Srinivasan, A current review of machine
learning and deep learning models in oral cancer diagnosis: Recent technologies,
open challenges, and future research directions, Diagnostics 13 (7) (2023) 1353.
[19] Qing Zhang, Dan Hou, Xueying Wen, Mengyu Xin, Ziling Li, L. Lihong Wu, J.L.
Pathak, Gold nanomaterials for oral cancer diagnosis and therapy: Advances,
challenges, and prospects, Mater. Today Bio 15 (2022).
[20] Y. Liu, J. Dong, J. Zhang, Q. Wang, H. Wang, X. L, A deep learning-based CAD
system for oral cancer detection using multimodal images, IEEE Trans. Med.
Imaging 41 (1) (2022) 261–271.
12
Healthcare Analytics 3 (2023) 100199
[21] A. Menegola, J.G. Tavares, S. A, Deep learning based oral cancer detection using
convolutional neural network, J. Appl. Oral Sci. 27 (2019) e20180637.
[22] Y. Yang, X. Zhang, Y. Zhao, X. Z, Early detection of oral cancer using salivary
exosomes and deep learning, Front. Oncol. 12 (2022).
[23] Y. Wang, W. Chen, Q. P, Automatic segmentation of oral cancer regions based
on the residual U-Net with deep supervision, Comput. Med. Imaging Graph. 98
(2022).
[24] J. Zhou, O. Troyanskaya, A. B, A regularization approach to solving sparse and
low-rank matrices, J. Mach. Learn. Res. 20 (7) (2019) 1–43.
[25] T. Leng, C. Li, L.L. Y. Li, X. W, A deep convolutional neural network for detecting
tongue cancer from intraoral images, J. Med. Syst. 46 (1) (2022).
[26] Y.G.S.S.R. Kumar, A systematic review of artificial intelligence techniques
in cancer prediction and diagnosis, Arch. Comput. Methods Eng. 29 (2022)
2043–2070.
[27] S. Sharma, A. Aggarwal, T. Choudhury, Breast cancer detection using machine
learning algorithms, in: International Conference on Computational Techniques,
Belgum, 2018.
[28] Hela Elmannai, Monia Hamdi, Abeer AlGarni, Deep Learning Models Combining
for Breast Cancer Histopathology Image Classification.
[29] A.-u. Rahman, A. Alqahtani, N. Aldhafferi, M. Nasir, M. Khan, M. Khan,
A. Mosavi, Histopathologic oral cancer prediction using oral squamous cell
carcinoma biopsy empowered with transfer learning, Sensors 22 (2022) 3833.
[30] C.A. Hamm, C.J. Wang, L.J. Savic, M. Ferrante, I. Schobert, T. Schlachter, Deep
learning for liver tumor diagnosis part I: development of a convolutional neural
network classifier for multi-phasic MRI, Eur. Radiol. 29 (2019) 3338–3347.
[31] N. Patel, A. Mishra, Automated leukaemia detection using microscopic images,
Procedia Comput. Sci. 58 (2015) 635–642.
[32] H. Xie, D.Y.N. Sun, Z. Chen, Y. Zhang, Automated pulmonary nodule detection
in CT images using deep convolutional neural networks, Pattern Recognit. 85
(2019) 109–119.
[33] Y. Wang, et al., Deep learning enhances polarization speckle for in vivo skin
cancer detection, Opt. Laser Technol. 140 (2020).
[34] M. Toğaçar, Z. Cömert, B. Ergen, Chaos, Intelligent skin cancer detection applying
autoencoder, MobileNetV2 and spiking neural networks, Solitons Fractals 144
(2021) 110714.
[35] H. Chen, Deep learning-based classification of dermoscopic images of melanoma
and nevus, IEEE J. Biomed. Health Inf. 24 (3) (2020) 981–990.
[36] M. Jindal, M.K. Dutta, An efficient deep learning approach for skin cancer
detection, J. Ambient Intell. Humaniz. Comput. 10 (1) (2019) 287–296.
[37] Y.J. Kim, B.H. Kang, H.S. Jung, M.J. Park, M.J. K, A deep learning-based
automated diagnostic system for distinguishing between benign and malignant
skin lesions, Comput. Methods Programs Biomed. 215 (2022).
[38] G. Argenziano, Dermoscopy: The ultimate tool for melanoma diagnosis, Semin.
Cutan. Med. Surg. 31 (3) (2012) 70–178.
[39] M. R, In vivo confocal scanning laser microscopy of human skin II: advances in
instrumentation and comparison with histology, J. Investig. Dermatol. 113 (3)
(1999) 293–303.
D. Raval and J.N. Undavia
[40] A. E, Dermatologist-level classification of skin cancer with deep neural networks,
Nature 542 (2017) 115–118.
[41] I. Kousis, I. Perikos, I. Hatzilygeroudis, M. Virvou, Deep learning methods for
accurate skin cancer recognition and mobile application, Electronics 1294 (2022)
11.
[42] a.g.w.o.b., R. Mohakud, R. Dash, Designing a grey wolf optimization based hyper-
parameter optimized convolutional neural network classifier for skin cancer
detection, J. King Saud Univ. Inf. Sci. (2021).
[43] M.A. K, A.R. S, Skin cancer detection: Applying a deep learning based model
driven architecture in the cloud for classifying dermal cell images, Inform. Med.
Unlocked 18 (100282) (2020).
[44] P. Srinivasu, J. SivaSai, M. Ijaz, A. Bhoi, W. Kim, J. Kang, Classification of
skin disease using deep learning neural networks with MobileNet V2 and LSTM,
Sensors 21 (2021) 2852.
[45] L. P, et al., The accuracy of visual methods for detecting oral cancer: a meta-
analysis, Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 96 (3) (2003)
382–391.
[46] C.F. P, Fluorescence visualization detection of field alterations in tumor margins
of oral cancer patients, Clin. Cancer Res. 12 (22) (2006) 6716–6722.
[47] H. Yoshida, Narrow-band imaging system with magnifying endoscopy for the
screening of esophageal cancer in patients with head and neck cancer, Int. J.
Oncol. 37 (5) (2010) 1193–1200.
[48] X. Zhou, An artificial intelligence system for the diagnosis of oral cancer based
on the surface-enhanced Raman spectroscopy of saliva, J. Biophotonics 14 (5)
(2021).
[49] S.S. H, M.S. K, W. L, G.H. P, I. P, S.E. Chang, T. P, Classification of the
clinical images for benign and malignant cutaneous tumors using a deep learning
algorithm, J. Investig. Dermatol. 138 (7) (2018) 1529.
[50] N.C. Codella, et al., Skin lesion analysis toward melanoma detection, in: A
Challenge at the 2017 International Symposium on Biomedical Imaging (ISBI),
Hosted by the Int, 2018.
[51] Y.S. Xulei, Zeng, Yeo, Colin Tan, Hong Liang Tey, Yi Su, A novel multi-task deep
learning model for skin lesion segmentation and classification, 2017.
13
Healthcare Analytics 3 (2023) 100199
[52] Christian Szegedy, Wei Liu, Yangqing Jia, Pierre Sermanet, Scott Reed, Dragomir
Anguelov, Dumitru Erhan, Vincent Vanhoucke, Rabinovich Andrew, Going
Deeper with Convolutions, arXiv, arXiv:1409.4842v1.
[53] T. Li, X. Ding, Y. Gao, Y. G, A novel CNN-based algorithm for automatic detection
of malignant, 2019.
[54] Ajitesh Kumar, Different types of CNN architectures explained: Examples, Data
Anal. (2022).
[55] Ponnapalli Haripriya, a.R. Porkodi, Deep learning pre-trained architecture of alex
net and googlenet for DICOM image classification, Int. J. Sci. Technol. Res. 8
(11) (2019) 3130–3136.
[56] http://learnopencv.com/wp-content/uploads/2018/05/AlexNet-1.png, [Online].
[57] Hirokatsu Kataoka, Kenji Iwata, Satoh Yutaka, Feature evaluation of deep
convolutional neural networks for object recognition and detection, 2015, arXiv:
1509.07627.
[58] Kaiming He, Xiangyu Zhang, Shaoqing Ren, Jian Sun, Deep residual learning for
image recognition, 2015, arxiv, http://arxiv.org/abs/1512.03385.
[59] L. Yu, H. Chen, Q. Dou, J. Qin, P.A. H, Automated melanoma recognition in
dermoscopy images via very deep residual networks, IEEE Trans. Med. Imaging
36 (4) (2018) 994–1004.
[60] Shukla Abhilash, A. Patel, Abnormality detection from X-ray bone images using
DenseNet convolutional neural network, Int. J. Curr. Res. Rev. (2021) http:
//dx.doi.org/10.31782/IJCRR.2021.131026.
[61] L. Waikhom, P. R, Graph neural networks: Methods, applications, and
opportunities, 2021.
[62] https://neptune.ai/blog/graph-neural-network-and-some-of-gnn-applications.
[63] H.C.d.B. BCN_20000 Dataset: (c) Department of Dermatology.
[64] M.D. Anonymous, https://arxiv.org/abs/1710.05006 and https://arxiv.org/abs/
1902.03368.
[65] HAM10000 Dataset: (C) by ViDIR Group, Department of Dermatology, Medical
University of Vienna, http://dx.doi.org/10.1038/sdata.2018.161.
[66] A.G.C. Pacheco, G.R. Lima, A.S. Salomão, B. Krohling, I.P. Biral, G.G. de Angelo,
F.C.R. Alves Jr., J.G.M. Esgario, A.C. Simora, P.B.C. Castro, F.B. Rodrigues, P.H.L.
Frasson, Kro, DataSet.