di Meo 2016.

Study characteristics
Patient sampling	Study design: case series Data collection: retrospective image selection/prospective interpretation Period of data collection: February‐December 2014 Country: Italy
Patient characteristics and setting	Inclusion criteria: melanocytic skin lesions that underwent excision Setting: secondary (general dermatology) Prior testing: selected for excision (no further detail) Setting for prior testing: secondary (general dermatology) Exclusion criteria: acral and mucosal lesions; dysplastic naevi excluded; disagreement between evaluators on tumour histological classification ‐ lesions that did not meet at least 2 consents were excluded; poor‐quality index test image (considered under flow and timing) Sample size (participants): number included: 125 Sample size (lesions): number included: 125 Participant characteristics: mean age: men 44.6 years; women 50.0 years; male: 61; 58% Lesion characteristics: thickness ≤ 1 mm: all 32 melanomas
Index tests	Dermoscopy 3PCL; scored 3‐point '4‐point checklist' (authors' own scoring); CASH algorithm Method of diagnosis: dermoscopic images Prior test data: no further information used Diagnostic threshold: 3PCL ≥ 2 criteria present; CASH score > 7; 4‐point checklist > 2 Diagnosis based on: unclear; lesions were "randomly assessed by two independent dermatologists" not clear if average or consensus; n = 2 Observer qualifications: dermatologist Experience in practice: high Experience with dermoscopy: high; dermatologists with > 7 years of experience in dermoscopy Any other detail: The 3PCL criteria: asymmetry in colour and/or structures in 1/2 axes, pigmented network with thickened lines and irregular distribution, and any blue and/or white structure within the lesion CASH algorithm has 4 criteria: colour, architectural disorder, symmetry and homo/heterogeneity. Scoring described in detail 4‐point checklist; doubled all 3 criteria of the 3PCL and chose the one conferring more sensitivity, specificity and accuracy (symmetry parameter doubled)
Target condition and reference standard(s)	Reference standard: histological diagnosis alone All lesions were excised and independently analysed by 2 dermatopathologists. The diagnosis of dysplastic naevus was based on the histopathological diagnostic criteria set by the World Health Organization Melanoma Programme (Clemente 1991). It was considered as a benign lesion Disease‐positive: 32; disease‐negative: 93 Target condition (final diagnoses) Melanoma (in situ and invasive, or NR): 32 Mild/moderate dysplasia: 50; benign naevus: 43
Flow and timing	Excluded participants: dysplastic naevi (n = 50) excluded from 2x2; poor‐quality index test images ‐ exclusion criterion Interval between index and reference standard: not clearly described
Comparative
Notes	‐
Methodological quality
Item	Authors' judgement	Risk of bias	Applicability concerns
DOMAIN 1: Patient Selection
Was a consecutive or random sample of patients enrolled?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	No
Are the included patients and chosen study setting appropriate?	No
Did the study avoid including participants with multiple lesions?	Yes
		High	High
DOMAIN 2: Index Test Dermoscopy ‐ image‐based
Were the index test results interpreted without knowledge of the results of the reference standard?	Yes
If a threshold was used, was it pre‐specified?	Yes
For studies reporting the accuracy of multiple diagnostic thresholds, was each threshold or algorithm interpreted without knowledge of the results of the others?	Unclear
Was the test applied and interpreted in a clinically applicable manner?	No
Were thresholds or criteria for diagnosis reported in sufficient detail to allow replication?	Yes
Was the test interpretation carried out by an experienced examiner?	Yes
		Low	High
DOMAIN 3: Reference Standard
Is the reference standards likely to correctly classify the target condition?	Yes
Were the reference standard results interpreted without knowledge of the results of the index tests?	Unclear
Expert opinion (with no histological confirmation) was not used as a reference standard	Yes
Was histology interpretation carried out by an experienced histopathologist or by a dermatopathologist?	Yes
		Low	Low
DOMAIN 4: Flow and Timing
Was there an appropriate interval between index test and reference standard?	Unclear
Did all patients receive the same reference standard?	Yes
Were all patients included in the analysis?	No
If the reference standard includes clinical follow‐up of borderline/benign appearing lesions, was there a minimum follow‐up following application of index test(s) of at least: 3 months for melanoma or cSCC or 6 months for BCC?
If more than one algorithm was evaluated for the same test, was the interval between application of the different algorithms 1 month or less?	Yes
		High