Skin lesion segmentation is a key task in computer-aided dermatological diagnosis, where accuracy directly impacts downstream analysis and disease classification. However, dermoscopic images are challenging due to blurred boundaries, low contrast, large shape variations, and artifacts such as hair and shadows. Recently, diffusion models have shown strong performance in medical image segmentation thanks to their progressive denoising and distribution modeling capabilities. Nevertheless, existing diffusion-based methods still suffer from limited cross-level feature interaction and insufficient boundary detail recovery. To address these issues, we propose MLFFM-SegDiff, a multi-level feature fusion diffusion model for skin lesion segmentation. Built on a diffusion framework, the method introduces a dual-path U-Net encoder, a Multi-Level Feature Fusion Module (MLFFM), and a boundary-sensitive loss function. The dual-path encoder enhances interaction between noisy mask features and dermoscopic image features. MLFFM improves skip connections via attention, scale alignment, and adaptive cross-level fusion. These designs enable the decoder to jointly leverage shallow boundary cues and deep semantic representations, improving mask reconstruction quality. Experiments on ISIC2018, PH2, and HAM10000 demonstrate that MLFFM-SegDiff outperforms representative methods including DermoSegDiff, U-Net, and SwinUNETR across Accuracy, F1-score, Jaccard index, Recall, and Dice. In particular, it achieves an average Jaccard index of 0.8546 and Dice coefficient of 0.9207. These results validate the effectiveness of the proposed multi-level feature fusion strategy for improving lesion segmentation performance. The code will be released at https://github.com/Qacket/MLFFM-SegDiff.git after publication.

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