Perceptive Hierarchy of Facial Skin Lesions: An Eye-tracking Study.

Equal importance is given to every skin lesion in treatment guidelines and severity grading systems for facial lesions. Face recognition studies suggest differentially perceived areas of the human face. The aims of this study were to quantify the visual attention given to facial skin lesions and to explore their hierarchy. Eye movements were tracked in 118 participants who viewed 135 faces with facial skin lesions. The main effect of the image was significant (F[9, 1053]=15.631, p < 0.001, η2=0.118), which implied a difference in the total visual attention between images depicting skin lesions in different aesthetic units. Lesions in the frontal area received the highest area- specific attention, while lesions in the right parotid area had the smallest effect. Using objective computational clustering, 2 very distinct zones of visual attention were identified: the ocular, nasal, perioral, and frontal areas attracted high visual scrutiny and the remaining areas attracted little attention. However, the presence of skin lesions in the high-attention region resulted in a decrease in total visual attention to the face. The main effect of the aesthetic unit was significant (F[15, 1755]=202.178, p < 0.001, η2=0.633). More than 63% of attention-drawing potential of facial skin lesions depends on their anatomical location, which should be considered in disease severity grading and treatment planning.