PelliScope: Intelligent Skin Health with AI Attention-Based Multi-Instance Learning for Real-World Dermatology Background: A Critical Gap in Dermatology AI Standard AI Single image inputs GAP close-up context angled Clinical Reality Multi-photo cases Objective: A Compute-Efficient, Case-Level Pipeline Aggregate 1-3 photos per case via Multiple Instance Learning (MIL). Leverage frozen dermatology foundation embeddings for efficiency. Deliver tunable operating points for 10 common conditions. Diagnostic Classes: Eczema, Allergic & Irritant Contact Dermatitis, Insect Bite, Urticaria, Psoriasis, Folliculitis, Tinea, Herpes Zoster, & Drug Rash. Methods: Comprehensive Evaluation of Multiple Instance Learning Model Input: Proprietary Dataset Client's proprietary dataset 10 diagnostic skin lesion classes Step 1: Feature Extraction Frozen Derm Foundation Encoder (vs. ResNet, ViT, CLIP, etc.) Step 2: Case-Level Learning Gated-Attention MIL Head (Trained with AdamW, cb-BCE) Output Case-Level Diagnosis (Micro/Macro AUC) Results: Outperforms Open & Closed Models Micro ROC-AUC for 10 Diagnostic Classes Grok-4 0.702 GPT-5 0.81 Gemini 2.5 0.82 CLIP + RF 0.802 Derm F. + G. Boost 0.841 PelliScope 0.863 +0.022 Conclusion: A Practical Path to Deployable AI High Overall Accuracy: Achieves mean accuracy of 0.802 on the test set. Clinically Meaningful: Tunable thresholds for specific needs. e.g., Urticaria: Sensitivity 0.818, Specificity 0.826 Efficient & Deployable: Lightweight model on frozen features. ~6–7s inference on a consumer CPU The solution is acknowledged by Emirates Health Services (UAE) to be implemented in their workflow. (Acknowledgement Letter)