For clinical deployment, it is essential that automated diagnostic systems remain reliable when confronted with previously unseen cases, yet deep models routinely misclassify out-of-distribution (OOD) inputs with high confidence, underscoring the need for more robust OOD detection methods. Although substantial effort has been devoted to improving model robustness, most of the existing literature assumes balanced datasets, evaluates OOD detection on coarse or non-clinical OOD sources, or lacks comprehensive assessment across diverse OOD scenarios. To address the gaps, we propose a novel methodology trained on diverse and imbalanced medical datasets and evaluated across a clinically reflective OOD spectrum. Our framework comprises three key components: (1) a Nonlinear von Mises-Fisher (NvMF) classifier capable of learning non-linear decision boundaries, with theoretical proof of its asymptotic connection to cosine classifiers; (2) a multi-expert framework in which margin-aware NvMF classifiers specialise in different regions of label distribution to better handle imbalance; and (3) an outlier expert trained explicitly to distinguish inlier from outlier data, thereby strengthening OOD detection. Evaluation on RFMiD, ISIC2019, and NCTCRC datasets demonstrates consistent improvements over state-of-the-art methods, achieving mean FPR95 reductions of 8.45%, 13.02%, and 36.90% respectively. These gains are further supported by comprehensive ablations that validated the contributions of each component. This enables reliable identification of unfamiliar cases for deferral to clinicians, supporting safer AI-assisted diagnosis in real-world workflows. Our code is available at https://github.com/redboxup/MARVEL.
Prototype-based neural networks aim to provide intrinsic interpretability by grounding predictions in a small set of part prototypes. However, modern vision backbones typically operate in normalized, directional embedding spaces where each semantic part exhibits substantial intra-class variability. As a result, point prototypes often become redundant or unstable, hurting both explanation quality and robustness. We propose vMFProto, a distributional part-prototype framework that models each class as a mixture of von Mises-Fisher components on the hypersphere. Each prototype learns its own concentration, capturing part-specific variability, and we use entropic optimal transport (OT) to obtain structured patch-to-prototype assignments. A two-stage training schedule performs OT-driven prototype discovery followed by end-to-end refinement with patch-level distillation and distribution-aware diversity regularization. Experiments with frozen DINO backbones show that vMFProto achieves leading consistency and distinctiveness on CUB-200-2011 and competitive classification accuracy across CUB, Stanford Dogs, and Stanford Cars. Qualitative results confirm that vMFProto yields localized, non-redundant part evidence.