This book constitutes the refereed proceedings of the 201st International Workshop on Combinatorial Image Analysis, IWCIA 2022, held in Messina, Italy, in July 2022.The 20 full papers presented were carefully reviewed and selected from 24 submissions. The papers are grouped into four sections. The first one consists of one invited talk. The second section contains seven papers devoted to digital geometry and topology. The third part consists of six papers discussing picture languages. The last part, including six papers, is devoted to various applications. We believe that many of these papers would be of interest to a broader audience, including researchers in scientific areas such as computer vision, shape modeling, pattern analysis and recognition, and computer graphics.