Unlu 2014.

Study characteristics
Patient sampling	Study design: case series Data collection: retrospective image selection/prospective interpretation Period of data collection: January 2008‐January 2010 Country: Turkey
Patient characteristics and setting	Inclusion criteria: melanocytic lesions excised at Ankara University Department of Dermatology Pigmented Lesion Clinic Setting: specialist unit; Ankara University Department of Dermatology Pigmented Lesion Clinic Prior testing: selected for excision (no further detail) Setting for prior testing: specialist unit (skin cancer/PLC) Exclusion criteria: location/site of lesion facial, nail and volar acral lesions were excluded; non‐melanocytic appearance Sample size (participants): number included: 115 Sample size (lesions): number included: 115 Participant characteristics: mean age: 38.72 years (+/‐ 18.46 years). Male: 56 (49%) Lesion characteristics: lesion site: 100% trunk and limbs. Melanoma thickness: 10 (41.7%) < 0.75 mm; 14 (58.3%) ≥ 0.75 mm
Index tests	VI: no algorithm; appears to be original clinical diagnosis at time of lesion presentation Method of diagnosis: in‐person diagnosis. Appears to be diagnosis on presentation Prior test data: N/A; in‐person diagnosis Other test data: dermoscopic images presented to different observers Diagnostic threshold: NR Diagnosis based on: unclear; for VI appears to be single examiner at time of clinic diagnosis (n = NR); dermoscopic images "scored by three other experienced dermatoscopists" Observer qualifications: NR; assumed dermatologists; described as experienced dermatoscopists Experience in practice: unclear for clinic diagnosis; dermatoscopists described as "experienced" Experience with index test: described as "experienced" Dermoscopy 3‐point rule; 7PCL; ABCD; CASH algorithm Method of diagnosis: dermoscopic images Prior test data: no further information used; clinical image evaluation appears to be separate from dermoscopy interpretation Diagnostic threshold: ABCD score ≥ 5.45 highly suggestive for melanoma; 7‐point score ≥ 3; 3‐point score 2 or 3 criteria present; CASH algorithm ≥ 8 Observers: as described for Visual Inspection above
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Disease‐positive: 24; disease‐negative: 91 Target condition (final diagnoses) Melanoma (in situ and invasive, or NR): 24 'Benign' diagnoses: 91 melanocytic benign lesions; 37 (32.2%) dermal naevi; 15 (13%) Clark's naevi; 14 (12.2%) compound naevi; 13 (11.3%) blue naevi; 6 (5.2%) SN; 4 (3.5%) congenital melanocytic naevi; 2 (1.7%) junctional naevi
Flow and timing	Excluded participants: none reported Time interval to reference test: NR
Comparative	Blinding between tests: used in‐person clinical diagnosis; clinical image evaluation appears to be separate from dermoscopy interpretation Time interval between index test(s): appear to be consecutively applied but not described
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?	Yes
Are the included patients and chosen study setting appropriate?	No
Did the study avoid including participants with multiple lesions?	Yes
		Low	High
DOMAIN 2: Index Test Visual Inspection ‐ in‐person
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?	Yes
Were thresholds or criteria for diagnosis reported in sufficient detail to allow replication?	No
Was the test interpretation carried out by an experienced examiner?	Unclear
		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?	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?	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
DOMAIN 5: Comparative
Was each index test result interpreted without knowledge of the results of other index tests or testing strategies?	Yes
Was the interval between application of the index tests less than one month?	Unclear
Were all tests applied and interpreted in a clinically applicable manner?	No
		Unclear	High