Rubegni 2012.

Study characteristics
Patient sampling	Study design: case series Data collection: retrospective image selection/prospective interpretation Period of data collection: January2008‐December 2010 Country: Italy
Patient characteristics and setting	Inclusion criteria: all palmoplantar PSLs observed and removed because of the presence of clinical and/or dermoscopic suspicious features and in the absence of any clear benignity pattern (parallel furrow pattern, lattice‐like pattern or fibrillar pattern). Setting: secondary (general dermatology) Prior testing: clinical and/or dermatoscopic suspicion Setting for prior testing: secondary (general dermatology) Exclusion criteria: non‐acral lesions; site of lesion in volar skin of the folds near the toes; lesion size > 26 mm diameter; non‐melanocytic appearance; elevated or ulcerated appearance Sample size (participants): number included: 107 Sample size (lesions): number included: 107 Participant characteristics: mean age: 49.8 years (women); 44.9 years (men); range 19‐73 years; male: 58.9%; ethnicity white: 100% Lesion characteristics 78 on soles and 19 on palms; 9 (36%) melanomas ≤ 0.75 mm (incl 4 in situ); 11 (44%) 0.76‐1.5 mm in 11/25 lesions; 5 (20%) ≥ 1.50 mm
Index tests	Dermoscopy: pattern analysis; 3‐step algorithm for palmoplantar lesions (Koga 2011) Method of diagnosis: dermoscopic images Prior test data: no further information used Diagnostic threshold: clinical diagnosis (melanoma/no melanoma). For the 3‐step algorithm the conventional options are "removal, follow‐up or no follow‐up"; the latter 2 were combined under the term ‘no melanoma’ for study purposes Diagnosis based on: single observer (n = 2; one per algorithm) Observer qualifications: dermatologist Experience in practice: high Experience with dermoscopy: high; 2 dermatologists with 20 years’ experience in dermoscopy Any other detail: ELM images achieved with the DB‐Mips System; (magnification x 16)
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Details: "Histopathological diagnosis was based on the criteria of the National Institute of Health Consensus Conference" Disease‐positive: 25; disease‐negative: 82 Target condition (final diagnoses) Melanoma (invasive): 21; melanoma (in situ): 4 'Benign' diagnoses: 82
Flow and timing	Participant exclusions: none reported Index test to reference standard interval: not 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?	Yes
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?	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