I developed the current #1 ranking leaderboard model and seems like a good time to stop lurking and chime in... It's no surprise that a dramatically simpler model fit to the narrow ~11 label prediction task outperforms an LLM where the same task is a drop in the ocean with regards to its training corpus.

What is maybe more interesting is that, despite the availability of open weight medical image-language embedding models like Google's MedSigLIP AND the opportunity to adapt them, they don't seem to break into the Top-10. My impression is that the joint representation is valuable down-stream of the diagnostic classification task for interpretation, communication, and management of the risk, but the language corpus for dermatology images are full of 'human engineered' descriptive features (think Bitter Lesson), and we should be looking past clinical semantics for more informative visual features if we want to push the limits of performance and generalizability. Ultimately, this seems necessary: people are immediately and persistently aware of the presence and extent of their skin conditions, the skin is the most readily accessible to imaging by patients themselves, smartphones have remarkable macroscopic photo capability, and there is huge demand for dermatology care.