Masked Privileged-Information Distillation for Multimodal Skin Lesion Classification Under Missing Clinical Metadata

Abstract

Multimodal skin lesion classification combines clinical images with patient metadata to improve diagnostic accuracy. However, complete metadata available during training may be only partially accessible at deployment, and resource-constrained settings additionally require computational efficiency. We address these challenges with a privileged-information distillation framework in which a multimodal teacher trained on complete metadata supervises a 9.2x smaller student trained with randomly masked clinical fields. Clinical fields are masked as whole groups at a per-sample rate drawn from U(0,1), so one training run covers the full metadata availability range. Fusion is residual, with metadata added as a gated correction to an unconditional image base. On the PAD-UFES-20 dataset, distillation under masked training improves balanced accuracy over cross-entropy training at every availability level, by an average of +4.7 points versus +1.8 points without masking. The masked student loses only 7.8 balanced-accuracy points as metadata decreases from complete to absent, compared with 36.6 points for the same student trained on complete metadata, highlighting the role of masked training in graceful degradation beyond distillation alone. Grad-CAM visualizations further show that the masked student's attention generally remains lesion-centered as metadata is withdrawn. The resulting compact model targets point-of-care settings, where clinical metadata is often incomplete.