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原文摘要

Skin lesion segmentation without annotated masks requires the target to be specified through other cues. Existing approaches rely on dermoscopy-specific rules, annotation-derived model priors, or user-selected regions. A general text-to-image diffusion transformer offers a text interface to the target, but its concept-word attention is unreliable on dermoscopy images: in the model's attention-output space, the word-derived skin-to-lesion direction is poorly aligned with the direction separating real skin from real lesions. We show that the direction derived from generated healthy-skin and lesion images is substantially better aligned. Based on this finding, we propose GENIQ, a training-free method that constructs initial skin and lesion prototypes from generated images and refines them using the most skin-like and lesion-like patches from unlabelled dermoscopy images. It scores test patches along the refined direction and applies a gated threshold to suppress contextual spill-over around small lesions. Without inference-time annotations or additional models, GENIQ achieves Dice scores of 0.85-0.88 on three dermoscopy test sets. It outperforms zero-shot and word-based attention methods on all three sets, and a hand-designed dermoscopy pipeline in Dice and IoU on two.