Skin Lesions Research Articles

EADV Task Force Pruritus White Paper on chronic pruritus and chronic prurigo: Current challenges and future solutions.

Chronic pruritus (CP) is frequent in general medicine and the most common complaint in general dermatology. The prevalence of CP is expected to rise in the future due to the ageing population. The clinical presentation, underlying aetiology and treatment strategy of CP are heterogeneous. Also, individual treatment aims and physical, psychic and economic burdens of patients might vary. Chronic prurigo (CPG) is the most severe disease in the chronic pruritus spectrum, being associated with long-standing scratch-induced skin lesions and a therapy refractory itch-scratch-cycle. It is thus important to raise disease awareness for CP and CPG in the general public and among decision-makers in the health system. Further, there is a need to support a rational clinical framework to optimize both diagnostics and therapeutics. Currently, there is still a shortcoming regarding approved therapies and understanding CP/CPG as severe medical conditions. Therefore, the EADV Task Force Pruritus decided to publish this white paper based on several consensus meetings. The group consented on the following goals: (a) ensure that CP is recognized as a serious condition, (b) increase public awareness and understanding of CP and CPG as chronic and burdensome diseases that can greatly affect a person's quality of life, (c) clarify that in most cases CP and CPG are non-communicable and not caused by a psychiatric disease, (d) improve the support and treatment given to patients with CP to help them manage their disease and (e) publicize existing therapies including current guidelines. We aim to point to necessary improvements in access and quality of care directed to decision-makers in health policy, among payers and administrations as well as in practical care.

Atypical skin conditions of the neck and back as a dermal manifestation of anti-HMGCR antibody-positive myopathy

BackgroundImmune-mediated necrotizing myopathy (IMNM) is an idiopathic inflammatory myopathy (IIM). Though patients with IMNM were not considered to show skin rash, several reports have showed atypical skin conditions in patients with anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody-positive IMNM (HMGCR-IMNM). The incidence and phenotype of skin conditions in patients with HMGCR-IMNM are not fully known.ResultsAmong the 100 IIM patients diagnosed from April 2015 through August 2022, 34 (34%) presented some form of skin condition, with 27 having typical skin rashes; this included 13 patients with dermatomyositis (DM), 8 with anti-synthetase syndrome (ASS), and 6 with IMNM. Meanwhile, 8 of 19 patients with HMGCR-IMNM (42%) presented atypical skin lesions, but no patients with other IIMs did (p < 0.001). Skin eruption with ash-like scales was observed in four HMGCR-IMNM patients, and non-scaly red patches and lumps in the other four patients; accordingly, their skin manifestations were considered as other dermal diseases except for IIM. However, skin and muscle biopsies revealed the atypical skin conditions of patients with HMGCR-IMNM to have the same pathological background, formed by Bcl-2-positive lymphocyte infiltrations.ConclusionsHMGCR-IMNM patients frequently have atypical skin conditions of the neck and back. Skin biopsy specimens from these lesions showed the same Bcl-2-positive lymphocytic infiltrations as muscle biopsy specimens regardless of the different gross dermal findings. Thus, such atypical skin conditions may be suggestive for HMGCR-IMNM.

Rate of Benign and Malignant Secondary Tumors Associated With Nevus Sebaceous: A Systematic Review and Meta-Analysis.

Nevus sebaceous (NS) is a rare congenital skin lesion affecting approximately 0.3% of all newborns. Although benign, NS lesions can harbor malignant secondary tumors. The published rate of development of these malignant tumors varies. This meta-analysis aimed to identify the rate of malignant and benign secondary neoplasms occurring in NS. A literature search was conducted using PubMed, Embase, and Web of Science from inception to April 2023. Eligible studies reported incidence or risk of secondary neoplasms in patients with NS. Two independent reviewers screened studies, extracted data, and assessed the quality of included studies. The primary outcome was the pooled incidence of secondary neoplasms. Studies with sample sizes greater than 50 patients were eligible for meta-analysis using the random-effects model. Twenty-eight studies were identified, 22 of which were eligible for meta-analysis. The overall rate of secondary neoplasms was 12.8% (95% confidence interval [Cl], 9.2%-17.6%). The rates of development of malignant and benign tumors were 2.4% (95% CI, 1.4%-4.1%) and 10.3% (95% CI, 7.5%-13.9%), respectively. The rate of development of basal cell carcinoma was 1.7% (95% CI, 0.9%-3.2%), whereas the rate of the development of syringocystadenoma papilliferum was 3.6% (95% CI, 2.5%-5.3%) and that if trichoblastoma was 2.6% (95% CI, 1.7%-3.8%). Although the rate of development of malignant tumors within a primary NS lesion is low, it is not negligible. Prophylactic early excision remains a viable approach to prevent secondary malignant neoplasms, address cosmetic and functional complications, and preempt the need for complex reconstruction in the future. We propose that resection of NS lesions in childhood remains a reasonable first-line option in the appropriate patient keeping in mind that it may leave an undesirable scar.

Analytic validation of convolutional neural network-based classification of pigmented skin lesions (PSLs) using unseen PSL hyperspectral data for clinical applications

Analytic validation of convolutional neural network-based classification of pigmented skin lesions (PSLs) using unseen PSL hyperspectral data for clinical applications

OIPFST: AI-based Fitzpatrick skin tone labelling utilizing skin lesions

OIPFST: AI-based Fitzpatrick skin tone labelling utilizing skin lesions

Silver and gold nanoparticles as a novel approach to fight Sarcoptic mange in rabbits

Various kinds of pets have been known to contract the ectoparasite Sarcoptes scabiei. Current acaricides are becoming less effective because of the resistance developed by the mite besides their adverse effects on the general activity and reproductive performance of domestic pets. For this reason, the present study aims to discover a novel and safe approach using silver and gold nanoparticles to fight Sarcoptic mange in rabbits as well as to explain their mechanism of action. 15 pet rabbits with clinical signs of Sarcoptic mange that were confirmed by the microscopic examination were used in our study. All rabbits used in this study were assessed positive for the presence of different developing stages of S. scabiei. Three groups of rabbits (n = 5) were used as follows: group (1) didn’t receive any treatment, and group (2 and 3) was treated with either AgNPs or GNPs, respectively. Both nanoparticles were applied daily on the affected skin areas via a dressing and injected subcutaneously once a week for 2 weeks at a dose of 0.5 mg/kg bwt. Our results revealed that all rabbits were severely infested and took a mean score = 3. The skin lesions in rabbits that didn’t receive any treatments progressed extensively and took a mean score = of 4. On the other hand, all nanoparticle-treated groups displayed marked improvement in the skin lesion and took an average score of 0–1. All NPs treated groups showed remarkable improvement in the microscopic pictures along with mild iNOS, TNF-α, and Cox-2 expression. Both nanoparticles could downregulate the m-RNA levels of IL-6 and IFγ and upregulate IL-10 and TGF-1β genes to promote skin healing. Dressing rabbits with both NPs didn’t affect either liver and kidney biomarkers or serum Ig levels indicating their safety. Our residual analysis detected AgNPs in the liver of rabbits but did not detect any residues of GNPs in such organs. We recommend using GNPs as an alternative acaricide to fight rabbit mange.

Integration of artificial intelligence with medical diagnostic sonography

AbstractRapid changes in artificial intelligence (AI) have already impacted the medical field. While the use of AI to assist medical diagnosis has been documented, AI is continually expanding within medical applications. AI applications in sonography and their effect on ultrasound examinations and sonographers are still indeterminate. Six papers were reviewed to investigate AI applications and effects within the sonography field. These papers provided results on a range of ultrasound applications including breast, obstetric, skin lesions, carotid, blood flow and cardiac ultrasound imaging when combined with AI. In this narrative review, the application of AI demonstrated that accuracy and speed of clinical diagnosis can be improved. These six aspects of ultrasound imaging combined with AI demonstrated the potential to assist the operator and clinicians with a diagnosis in various applications and settings. Additionally, AI can be beneficial to telehealth applications for rural and remote areas where healthcare access can be limited. These changes are opportunities to assist with medical care to provide benefits to patients, sonographers and clinicians as AI transitions to a positive integration within many aspects of clinical care.

Prurigo Nodularis: Pathogenesis and the Horizon of Potential Therapeutics

Chronic pruritus that lasts for over 6 weeks can present in various forms, like papules, nodules, and plaque types, with prurigo nodularis (PN) being the most prevalent. The pathogenesis of PN involves the dysregulation of immune cell–neural circuits and is associated with peripheral neuropathies, possibly due to chronic scratching. PN is a persistent and challenging condition, involving complex interactions among the skin, immune system, and nervous system. Lesional skin in PN exhibits the infiltration of diverse immune cells like T cells, eosinophils, macrophages, and mast cells, leading to the release of inflammatory cytokines and itch-inducing substances. Activated sensory nerve fibers aggravate pruritus by releasing neurotransmitters, perpetuating a vicious cycle of itching and scratching. Traditional treatments often fail, but recent advancements in understanding the inflammatory and itch transmission mechanisms of PN have paved the way for innovative therapeutic approaches, which are explored in this review.

Herpes Simplex Virus Dacryoadenitis Preceding Skin Vesicles.

Herpes simplex virus involvement of the orbit is rare. We report the case of an immunocompetent patient who presented with preseptal edema, erythema, decreased vision, and dacryoadenitis prior to the appearance of vesicular skin lesions and in the absence of corneal dendrites. The patient's clinical picture failed to improve on empiric therapy with intravenous antibiotics. The patient subsequently developed skin vesicles and a nucleic acid amplification swab of the ocular surface was positive for herpes simplex virus-1. The patient demonstrated rapid clinical improvement after initiation of oral antivirals. This is an unusual case of presumed herpes simplex virus dacryoadenitis preceding skin vesicles in an immunocompetent patient.

Chronic Prurigo

SummaryChronic prurigo (CPG) is a neuroinflammatory dermatosis characterized by prolonged pruritus lasting more than 6 weeks, pruriginous skin lesions, and repeated scratching.Patients with CPG suffer significantly from psychological distress and a marked impairment in their quality of life. The most common subtype of CPG is chronic nodular prurigo (CNPG, also called prurigo nodularis).In addition to the clinical features of CPG and the burden of disease, this CME article provides an overview of the significant advances in understanding the pathophysiology, including the associated therapeutic options for CPG. Dupilumab is the first approved therapy for moderate and severe CNPG to date from the European Medicines Agency (EMA) and the US Food &amp; Drug Administration (FDA). It also highlights other agents currently being studied in Phase II and Phase III clinical, randomized, placebo‐controlled trials. These include biologics such as nemolizumab (anti‐IL‐31‐RA‐mAb), vixarelimab/KPL‐716 (anti‐Oncostatin‐M receptor β‐mAb), and barzolvolimab/CDX‐0159 (anti‐KIT‐mAb), as well as Janus kinase inhibitors such as povorcitinib/INCB054707 and abrocitinib, and opioid modulators such as nalbuphine.

Hourly Feeding Regime of Modern Genetics Lactating Sows: Enhancing Productive Performance, Welfare, and Piglet Growth in Smart Farm-Based Systems

Effective management of lactating sows significantly influences various aspects of swine production. This study compared the impact of an hourly feeding regime and a five-times-daily feeding regime on the productive performance, body condition, and welfare of lactating sows, as well as on the growth performance of their offspring. Twenty-eight lactating sows (Landrace × Yorkshire) were divided into two groups: Group 1 was fed five times a day, and Group 2 was fed according to an hourly regime. The data were analyzed using independent-samples T-tests and the Mann–Whitney U test using Statistical Analysis System (SAS, 2011, Version 9.3) software. An hourly feeding regime positively affected (p &lt; 0.05) sows’ feed intake and body condition, significantly reducing the days from the weaning-to-estrus interval. Group 1 exhibited significantly higher (p &lt; 0.05) reductions in backfat thickness (BFT) and body condition score (BCS) during the weaning period compared to Group 2. Additionally, significant differences (p &lt; 0.05) were observed in regard to sow body weight loss, feed intake, piglet livability and mortality rate at weaning, sow index, and calculated milk yield. Feeding sows according to an hourly regime positively impacted their productive performance compared to those fed five times daily. No significant differences (p &gt; 0.05) were recorded in regard to the total number of piglets born, live births, mummified piglets, stillbirths, piglet mortality, litter size at weaning, and sow feed conversion ratio (FCR). However, the number of piglets weaned per sow per year (PSY) was numerically higher in Group 2 (p &gt; 0.05). The piglets from Group 2 had significantly higher (p &lt; 0.05) weaning weights and exhibited lower feed intake, greater weight gain, improved average daily gain, and greater litter size weight gain than those from Group 1. Statistically, sows from Group 2 exhibited a higher frequency of standing (p &lt; 0.05), which potentially contributed to the reduction in shoulder skin lesions in sows (p &gt; 0.05). In conclusion, an hourly feeding regime could optimize sow productive performance, body condition, milk yield, welfare, and piglet growth in swine production.

Dermatological Manifestations of COVID-19 Patients

Background: COVID-19 is a highly contagious respiratory tract infection caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was first identified in China, in December 2019. Almost 10% of the patients develop dermatological manifestations before the onset of respiratory illness, with cutaneous signs that can appear from before to several days after the diagnosis of COVID-19. We believe that the dermatologist can play an important role through early recognition of skin lesions suggestive of COVID-19, particularly in asymptomatic infections where this recognition could direct toward an early diagnosis of infection that certainly leads to a better prognosis. Objective: To explore the pattern of dermatological manifestations among COVID-19 Bangladeshi patients. Materials and Methods: A cross sectional study was carried out May 2020 to October 2021 with COVID 19 positive hospital admitted patients. Data were collected through a group of Dermatologists who were serving at COVID dedicated Hospitals. Dermatologists, who were working in different medical college hospital and health complexes, were attached with the study as research associate. Results: Among the muco-cutaneous findings, maculo-papular eruption 52(53.6%) was the most common, followed by chilblain like eruption 40(41.2%), petechiae or purpura 16 (16.5%), urticarial lesions 13(13.4%), vesicular lesion 10(10.3%), Bilateral conjunctivitis with clear/mucoid discharge 10 (10.3%), aphthous stomatitis 13 (13.4%), Alopecia 16(16.5%), Darkening of the face 13 (13.4%), Eczematoid reaction 13 (13.4%), livedo reticularis like eruption 5(5.2%) etc. Conclusion: The major dermatological patterns of COVID-19 can be classified as inflammatory reactions (maculopapular, urticarial and vesicular rashes), or lesions of vascular origin (chilblain like rashes, petechiae/purpura, and livedo reticularis like pattern).

Repair of a “long and narrow” skin defect of the upper extremity with a modified design of a compound SCIP flap: a series of 12 cases

BackgroundLarge skin lesions of the upper extremity tend to be ‘‘long and narrow’’ in shape, and the currently used repair and reconstruction protocols still have some drawbacks, including difficulty in closure of the donor area, poor cosmetic appearance of the donor and recipient areas, and low flap survival rates. The ilioinguinal flap has been more widely used for repair and reconstruction of various complex conditions. In order to improve the versatility of the flap design and to achieve better aesthetic results, we report a study on the improved design of Compound SCIP flap for repairing "long and narrow" large skin defects of the upper extremity by using a modified design of the ilioinguinal flap for the procurement of perforating blood vessels and flap excision.MethodsFrom April 2005 to August 2015, a total of 12 patients underwent this modified design procedure, in which the anterior branch of the fourth lumbar artery or the posterior intercostal artery was selected to provide blood supply for the perforator flap together with the superficial branch of the superficial iliac artery to meet the blood supply needs of the flap for the one-time repair of a large "long and narrow" skin defect in the upper limb. Patient demographics, flap characteristics, and associated complications were retrospectively analyzed.Results3 females and 9 males were included in this study, the mean age of the patients was 31.7 years (range, 22–44 years), the mean follow-up period was 15.3 ± 5.6 months (range, 7–24 months), and all patients had complete closure of the defect site and donor area, and all flaps survived.ConclusionsThe Compound SCIP flap presents some advantages in repairing 'long and narrow' skin defects in the upper limb. While ensuring the survival rate of the elongated ilioinguinal flap, it amplifies the benefits of the ilioinguinal flap and enhances skin utilization. This can serve as a beneficial choice for repairing 'long and narrow' skin defects in the upper limb.

SkinSwinViT: A Lightweight Transformer-Based Method for Multiclass Skin Lesion Classification with Enhanced Generalization Capabilities

In recent decades, skin cancer has emerged as a significant global health concern, demanding timely detection and effective therapeutic interventions. Automated image classification via computational algorithms holds substantial promise in significantly improving the efficacy of clinical diagnoses. This study is committed to mitigating the challenge of diagnostic accuracy in the classification of multiclass skin lesions. This endeavor is inherently formidable owing to the resemblances among various lesions and the constraints associated with extracting precise global and local image features within diverse dimensional spaces using conventional convolutional neural network methodologies. Consequently, this study introduces the SkinSwinViT methodology for skin lesion classification, a pioneering model grounded in the Swin Transformer framework featuring a global attention mechanism. Leveraging the inherent cross-window attention mechanism within the Swin Transformer architecture, the model adeptly captures local features and interdependencies within skin lesion images while additionally incorporating a global self-attention mechanism to discern overarching features and contextual information effectively. The evaluation of the model’s performance involved the ISIC2018 challenge dataset. Furthermore, data augmentation techniques augmented training dataset size and enhanced model performance. Experimental results highlight the superiority of the SkinSwinViT method, achieving notable metrics of accuracy, recall, precision, specificity, and F1 score at 97.88%, 97.55%, 97.83%, 99.36%, and 97.79%, respectively.

Editorial: Artificial intelligence in cutaneous lesions: where do we stand and what is next?

Editorial: Artificial intelligence in cutaneous lesions: where do we stand and what is next?

Relationship between sociodemographic, clinical, and laboratory characteristics and severity of COVID-19 in pediatric patients.

COVID-19 affects children less seriously than adults; however, severe cases and deaths are documented. This study objective is to determine socio-demographic, clinical and laboratory indicators associated with severe pediatric COVID-19 and mortality at hospital entrance. A multicenter, retrospective, cross-sectional study was performed in 13 tertiary hospitals in Bolivia. Clinical records were collected retrospectively from patients less than 18 years of age and positive for SARS-CoV-2 infection. All variables were measured at hospital entrance; outcomes of interest were ICU admission and death. A score for disease severity was developed using a logistic regression model. 209 patients were included in the analysis. By the end of the study, 43 (20.6%) of children were admitted to the Intensive care unit (ICU), and 17 (8.1%) died. Five indicators were independently predictive of COVID-19 severity: age below 10 years OR: 3.3 (CI95%: 1.1-10.4), days with symptoms to medical care OR: 2.8 (CI95%: 1.2-6.5), breathing difficulty OR: 3.4 (CI95%: 1.4-8.2), vomiting OR: 3.3 (CI95%: 1.4-7.4), cutaneous lesions OR: 5.6 (CI95%: 1.9-16.6). Presence of three or more of these risk factors at hospital entrance predicted severe disease in COVID-19 positive children. Age, presence of underlying illness, male sex, breathing difficulty, and dehydration were predictive of death in COVID-19 children. Our study identifies several predictors of severe pediatric COVID-19 and death. Incorporating these predictors, we developed a tool that clinicians can use to identify children at high risk of severe COVID-19 in limited-resource settings.

Umbilical keratinous cyst in a 7-year-old girl: A case report

Keratinous cysts, the most common kind of epidermal cysts, are filled with keratin originating from the epidermis, most often from the hair follicle. Keratinous cyst is one of the most common skin lesions and occurs most commonly in the face, head, trunk, extremities, and genitals. A 7-year-old girl reported to the pediatric surgery department with a painless, small tumor arising from her umbilicus. There was no history of trauma, and it has been slowly growing for the past many years. Clinical examination revealed a 3-cm-long skin tag with three small interconnected tumors from the umbilicus. It was soft, and the parts of the tumors looked like they contained whitish material inside. Her general and other systems, including the abdominal examinations, were within the normal limits. The tumor was resected through a sub-umbilical skin incision. She made an uninterrupted recovery. The excised specimens subjected to histology were reported as superficial keratinous cysts. Keratinous cysts are one of the most common benign skin lesions, but not the most common, at the umbilicus. Clinicians need to be aware of such pathology during the evaluation of the umbilical swellings and tumors, especially in children.

Cutaneous findings in patients with acromegaly and its relationship with concomitant endocrinopathies.

Skin changes in acromegaly are often the first sign of the disease. The aim of this study was to describe the cutaneous findings in patients with acromegaly. In addition, a secondary aim was to investigate the possible association of these findings with remission status and concomitant endocrinopathies. In this prospective multicenter study, 278 patients over the age of 18 years with acromegaly who were followed up in 14 different tertiary healthcare institutions were included. These patients, who were followed up by the Endocrinology Department, were then referred to a dermatologist for dermatological examination. The frequency of skin lesions was investigated by detailed dermatologic examination. Dermatological diagnosis is reached by clinical, dermatological and/or dermoscopic examination, and rarely skin punch biopsy examinations in suspicious cases. The possible association of the skin findings between remitted and nonremitted patients and with concomitant endocrinopathies were evaluated. The most common skin findings in patients with acromegaly in our study were skin tags (52.5%), cherry angiomas (47.4%), seborrhoea (37%), varicose veins (33%), acneiform lesions (28.8%), hyperhidrosis (26.9%) and hypertrichosis (18.3%). Hypertrichosis was significantly more prevalent in patients nonremitted (p: .001), while xerosis cutis was significantly more prevalent in patients remitted (p: .001). The frequency of diabetes mellitus and hypothyroidism was significantly higher in patients with varicose veins and seborrhoeic keratosis than those without. Additionally, the coexistence of hypothyroidism, hyperthyroidismand galactorrhea was significantly higher in patients with Cherry angioma than in those without Cherry angioma (p-values: .024, .034and .027, respectively). The frequency of hypogonadism in those with xerosis cutis was significantly higher than in those without (p: .035). Cutaneous androgenization findings such as skin tag, seborrhoea, acneand acanthosis nigricans are common in patients with acromegaly. Clinicians should be aware that skin findings associated with insulin resistance may develop in these patients. It can be said that the remission state in acromegaly has no curative effect on cutaneous findings. Only patients in remission were less likely to have hypertrichosis. This may allow earlier review of the follow-up and treatment of acromegaly patients presenting with complaints of hypertrichosis. Additionally, it can be said that patients with skin findings such as cherry angioma may be predisposed to a second endocrinopathy, especially hypothyroidism. Including dermatology in a multidisciplinary perspective in acromegaly patient management would be beneficial to detect cutaneous findings earlier.

Experimental Inoculation of Pigs with Monkeypox Virus Results in Productive Infection and Transmission to Sentinels

Monkeypox virus (MPXV) is a re-emerging zoonotic poxvirus responsible for producing skin lesions in humans. Endemic in sub-Saharan Africa, the 2022 outbreak with a clade IIb strain has resulted in ongoing sustained transmission of the virus worldwide. MPXV has a relatively wide host range, with infections reported in rodent and non-human primate species. However, the susceptibility of many domestic livestock species remains unknown. Here, we report on a susceptibility/transmission study in domestic pigs that were experimentally inoculated with a 2022 MPXV clade IIb isolate or served as sentinel contact control animals. Several principal-infected and sentinel contact control pigs developed minor lesions near the lips and nose starting at day 12 through 18 days post-challenge (DPC). No virus was isolated or viral DNA was detected from the lesions; however, MPXV antigen was detected by IHC in tissue from a pustule of a principal infected pig. Viral DNA and infectious virus were detected in nasal and oral swabs up to 14 DPC, with peak titers observed at 7 DPC. Viral DNA was also detected in nasal tissues or skin collected from two principal-infected animals at 7 DPC post-mortem. Furthermore, all principal-infected and sentinel control animals enrolled in the study seroconverted. In conclusion, we provide the first evidence that domestic pigs are susceptible to experimental MPXV infection and can transmit the virus to contact animals.

HST-MRF: Heterogeneous Swin Transformer With Multi-Receptive Field for Medical Image Segmentation.

The Transformer has been successfully used in medical image segmentation due to its excellent long-range modeling capabilities. However, patch segmentation is necessary when building a Transformer class model. This process ignores the tissue structure features within patch, resulting in the loss of shallow representation information. In this study, we propose a Heterogeneous Swin Transformer with Multi-Receptive Field (HST-MRF) model that fuses patch information from different receptive fields to solve the problem of loss of feature information caused by patch segmentation. The heterogeneous Swin Transformer (HST) is the core module, which achieves the interaction of multi-receptive field patch information through heterogeneous attention and passes it to the next stage for progressive learning, thus complementing the patch structure information. We also designed a two-stage fusion module, multimodal bilinear pooling (MBP), to assist HST in further fusing multi-receptive field information and combining low-level and high-level semantic information for accurate localization of lesion regions. In addition, we developed adaptive patch embedding (APE) and soft channel attention (SCA) modules to retain more valuable information when acquiring patch embedding and filtering channel features, respectively, thereby improving model segmentation quality. We evaluated HST-MRF on multiple datasets for polyp, skin lesion and breast ultrasound segmentation tasks. Experimental results show that our proposed method outperforms state-of-the-art models and can achieve superior performance. Furthermore, we verified the effectiveness of each module and the benefits of multi-receptive field segmentation in reducing the loss of structural information through ablation experiments and qualitative analysis.