Piccolo 2002a.

Study characteristics
Patient sampling	Study design: case series Data collection: retrospective image selection/prospective interpretation Period of data collection: NR; 6‐month period Country: Italy
Patient characteristics and setting	Inclusion criteria: pigmented lesions excised because of equivocal dermoscopic findings or at the patient’s request Setting: secondary (general dermatology); from authors' institution Prior testing: dermatoscopic suspicion; patient request for evaluation/excision Setting for prior testing: NR Exclusion criteria: none reported Sample size (participants): number included: 289 Sample size (lesions): number included: 341 Participant characteristics: mean age 33.6 years, range 3–83 years; male: 127 (43.9%); Fitzpatrick phototype I‐II (31.4%); type III (42%); type IV‐V (26.4%) Lesion characteristics: none reported
Index tests	Dermoscopy: no algorithm Method of diagnosis: clinical photographs and dermoscopic images. Cases were clinically and dermoscopically evaluated on a high‐resolution colour monitor, in a random sequence Prior test data: none; appears to be based on images only Diagnostic threshold: correct diagnosis of melanoma Diagnosis based on: single observer (n = 2) Observer qualifications: dermatologist; (dermatology?) resident Experience in practice: high, dermatologist had 5 years of experience; low, resident with minimal training in PSLs Experience with dermoscopy: high and low (resident had 6 months of experience, comprising 8 h of specialised training on 3 consecutive days and 2 h/week in routine dermoscopy)
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Details: "All excised lesions were examined histopathologically by a dermatopathologist" Disease‐positive: 13; disease‐negative: 328 Target condition (final diagnoses) Melanoma (in situ and invasive, or NR): 13 Sebhorrheic keratosis: 3; benign naevus: 316; dFs 7; angiomas 2
Flow and timing	Time interval to reference test: NR
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?	Unclear
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	Unclear
Are the included patients and chosen study setting appropriate?	No
Did the study avoid including participants with multiple lesions?	No
		Unclear	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?	Unclear
For studies reporting the accuracy of multiple diagnostic thresholds, was each threshold or algorithm interpreted without knowledge of the results of the others?
Was the test applied and interpreted in a clinically applicable manner?	Unclear
Were thresholds or criteria for diagnosis reported in sufficient detail to allow replication?	No
Was the test interpretation carried out by an experienced examiner?	Yes
		Unclear	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?	Yes
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?
		Unclear