Adaptive Conformal Redistribution for Inter-class Transitional Uncertainty in Medical Image Classification

Medical image classification is frequently complicated by transitional categories whose feature distributions overlap those of adjacent classes, producing ambiguous decision boundaries. Conformal prediction returns uncertainty-aware prediction sets, but these are not directly actionable in clinical screening, where a single decision is required. This work proposes adaptive conformal redistribution (AdaConRed), a label-free post-conformal decision rule that converts ambiguous prediction sets into refined class assignments. A five-stage pipeline is developed. Vision-language generative augmentation addresses minority-class scarcity; a frozen DermFoundation encoder provides embeddings; a lightweight multi-layer perceptron performs classification; an entropy-modulated, margin-aware nonconformity score constructs adaptive prediction sets; samples predicted as transitional with multi-label sets are reassigned to the most probable alternative class within the set, using only model outputs at inference. Evaluation uses the OSCC oral lesion and ISIC skin lesion benchmarks at a miscoverage level of 0.2. On the 3-class OSCC benchmark, overall accuracy improves from 73.54% to 77.38%, with oral cancer accuracy rising from 64.29% to 82.14% and benign accuracy from 56.57% to 70.20%. Reassignment of transitional samples reduces OPMD accuracy from 84.78% to 80.16%, consistent with the asymmetric cost of missed malignancy. On ISIC, overall accuracy improves from 85.83% to 87.19%, melanoma accuracy rising from 66.04% to 68.34%. AdaConRed outperforms LAC, APS and RAPS under an identical backbone and redistribution rule. Conformal prediction can be extended beyond uncertainty quantification toward actionable decision support where transitional disease categories are present, with gains concentrated in the clinically critical malignant categories. Code repository: https://github.com/saibal436ghosh/AdaConRed.