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Abstract Medical image segmentation provides various effective methods for accuracy and robustness of organ segmentation, lesion detection, and classification. Medical images have fixed structures, simple semantics, and diverse details, and thus fusing rich multi-scale features can augment segmentation accuracy. Given that the density of diseased tissue may be comparable to that of surrounding normal tissue, both global and local information are critical for segmentation results. Therefore, considering the importance of multi-scale, global, and local information, in this paper, we propose the dynamic hierarchical multi-scale fusion network with axial mlp (multilayer perceptron) (DHMF-MLP), which integrates the proposed hierarchical multi-scale fusion (HMSF) module. Specifically, HMSF not only reduces the loss of detail information by integrating the features of each stage of the encoder, but also has different receptive fields, thereby improving the segmentation results for small lesions and multi-lesion regions. In HMSF, we not only propose the adaptive attention mechanism (ASAM) to adaptively adjust the semantic conflicts arising during the fusion process but also introduce Axial-mlp to improve the global modeling capability of the network. Extensive experiments on public datasets confirm the excellent performance of our proposed DHMF-MLP. In particular, on the BUSI, ISIC 2018, and GlaS datasets, IoU reaches 70.65%, 83.46%, and 87.04%, respectively.