This paper is in the following e-collection/theme issue:

Publication Behavior, Journalogy, Scientometrics and Research Issues in Dermatology (27) Clinical Information and Decision Making (1339) Quality Improvement (226) Clinical Informatics (918) Methods and Instruments in Medical Informatics (106) Decision Support for Health Professionals (1145) Skin Cancer and Melanoma Prevention (110)

Published on in Vol 6 (2023)

Preprints (earlier versions) of this paper are available at https://preprints.jmir.org/preprint/43821, first published .
The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis

The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis

The Reporting and Methodological Quality of Systematic Reviews Underpinning Clinical Practice Guidelines Focused on the Management of Cutaneous Melanoma: Cross-Sectional Analysis

Authors of this article:

Mahnoor Khalid1 Author Orcid Image ;   Bethany Sutterfield2 Author Orcid Image ;   Kirstien Minley2 Author Orcid Image ;   Ryan Ottwell2 Author Orcid Image ;   McKenna Abercrombie3 Author Orcid Image ;   Christopher Heath3 Author Orcid Image ;   Trevor Torgerson2 Author Orcid Image ;   Micah Hartwell2 Author Orcid Image ;   Matt Vassar2 Author Orcid Image
Article Authors Cited by Tweetations (4) Metrics

    Original Paper

    1Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, United States

    2Oklahoma State University College of Osteopathic Medicine, Tulsa, OK, United States

    3Dermatology Residency, Trinity Health Ann Arbor Hospital, Ypsilanti, MI, United States

    Corresponding Author:

    Mahnoor Khalid, MS

    Office of Medical Student Research

    Oklahoma State University Center for Health Sciences

    1111 W 17th St

    Tulsa, OK, 74107

    United States

    Phone: 1 (918) 853 9938

    Email: mahnoor.khalid@okstate.edu


    Background: Clinical practice guidelines (CPGs) inform evidence-based decision-making in the clinical setting; however, systematic reviews (SRs) that inform these CPGs may vary in terms of reporting and methodological quality, which affects confidence in summary effect estimates.

    Objective: Our objective was to appraise the methodological and reporting quality of the SRs used in CPGs for cutaneous melanoma and evaluate differences in these outcomes between Cochrane and non-Cochrane reviews.

    Methods: We conducted a cross-sectional analysis by searching PubMed for cutaneous melanoma guidelines published between January 1, 2015, and May 21, 2021. Next, we extracted SRs composing these guidelines and appraised their reporting and methodological rigor using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) checklists. Lastly, we compared these outcomes between Cochrane and non-Cochrane SRs. All screening and data extraction occurred in a masked, duplicate fashion.

    Results: Of the SRs appraised, the mean completion rate was 66.5% (SD 12.29%) for the PRISMA checklist and 44.5% (SD 21.05%) for AMSTAR. The majority of SRs (19/50, 53%) were of critically low methodological quality, with no SRs being appraised as high quality. There was a statistically significant association (P<.001) between AMSTAR and PRISMA checklists. Cochrane SRs had higher PRISMA mean completion rates and higher methodological quality than non-Cochrane SRs.

    Conclusions: SRs supporting CPGs focused on the management of cutaneous melanoma vary in reporting and methodological quality, with the majority of SRs being of low quality. Increasing adherence to PRISMA and AMSTAR checklists will likely increase the quality of SRs, thereby increasing the level of evidence supporting cutaneous melanoma CPGs.

    JMIR Dermatol 2023;6:e43821

    doi:10.2196/43821

    Keywords

    clinical practice guidelines; clinical; cutaneous melanoma; decision making; evidence; management; melanoma; practice guideline; review; systematic review 


    Clinical practice guidelines (CPGs) are high-quality, evidence-based statements that have been used by health care professionals to bridge the gap between policies, best practices, local contexts, and patient preferences [1]. Through recommendations, CPGs are beneficial to medical practices by decreasing variances and mistakes in clinical practice, reducing health care costs, and improving health outcomes [1,2]. With CPGs offering various benefits to both the clinician and the patient, it is no surprise that CPGs are heavily relied upon in clinical settings and widely supported by practicing health care professionals [3,4]. Despite their widespread use and potential benefits, concerns about the quality of CPGs exist.

    Research evaluating the methodological quality and reporting clarity of systematic reviews (SRs) referenced in CPGs found variability in SR quality across various fields [5-8]. For example, CPGs focused on pediatric obesity based their recommendations primarily on low-quality SRs according to both the PRISMA (Preferred Reporting Instrument for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) appraisal instruments [7]. PRISMA is an appraisal tool that evaluates the completeness of the reporting of SRs, while AMSTAR evaluates the methodological quality of SRs [5-8].

    In dermatology, quality surveys of guidelines assessed by the Appraisal of Guidelines for Research and Evaluation Instrument (AGREE II) tool have been performed in various dermatologic conditions, including guidelines focused on the management of melanoma [9-11]. Although widely used, the AGREE II instrument was not designed to provide a comprehensive evaluation of the methodological rigor of the studies forming the guidelines and recommendations [12]. In 2020, a study found that the recommendations made by the American Academy of Dermatology (AAD) CPGs for the management of melanoma—one of the most recently published guidelines by the AAD—were supported by primarily moderate to low levels of evidence [13]. Interestingly, the lack of strong support exists despite a significant increase in published SRs and randomized controlled trials in dermatology, indicating a need for higher-quality studies [13-16]. Thus, to further improve clinical practice in dermatology, the evidence underpinning CPG recommendations needs to be rigorously developed and assessed [12,15].

    With regard to limitations, the primary aim of this study was to determine the reporting and methodological quality of SRs and meta-analyses cited in CPGs for the management of cutaneous melanoma by using AMSTAR and PRISMA appraisal instruments. Our secondary aim was to evaluate the number of Cochrane SRs cited in the CPGs and explore the differences between AMSTAR and PRISMA appraisals among Cochrane SRs and non-Cochrane SRs.


    Ethical Considerations

    This study contained no human subject data and was thus exempt from institutional review board oversight.

    Transparency, Reproducibility, and Reporting

    To ensure the reproducibility of this study, all data sets and analyses were publicly available on the Open Science Framework (OSF) [17]. Additionally, to further enhance reproducibility, all analyses were independently reevaluated in a masked fashion by a third-party statistician. Lastly, all search strategies, inclusion and exclusion criteria, and data extraction methods were pilot-tested a priori and adhered to this protocol.

    Outcomes

    The primary objective of this study was to determine the reporting and methodological quality of SRs and meta-analyses cited in CPGs for the management of cutaneous melanoma. The methodological quality of each SR was evaluated using AMSTAR and PRISMA appraisal tools. Next, this study evaluated the number of Cochrane SRs cited in the CPG and explored the differences between AMSTAR and PRISMA appraisals among Cochrane SRs and non-Cochrane SRs.

    Identification of Clinical Practice Guidelines

    To identify CPGs focused on cutaneous melanoma, a PubMed search was conducted by the author (TT). A customized search query (Multimedia Appendix 1) [1-16,18-21] was made with the aid of resources from the Canadian Agencies for Drugs and Technologies in Health [17] and the American Society of Clinical Oncology [22] and was used to identify relevant CPGs in PubMed.

    After performing our search, all returned CPGs were uploaded to Rayyan QCRI (Qatar Computing Research Institute), a screening platform, to undergo inclusion criteria screening. Our definition that was used to identify CPGs was adopted from the Institute of Medicine [19]. For a CPG to be included, the following must be met: (1) the focus of the CPG was on the management of cutaneous melanoma; (2) the CPG was published between January 1, 2015, and May 21, 2021; and (3) the CPG was retrievable in English. The screening of all CPGs was performed in a masked duplicate fashion by investigators (BS and MK).

    Identification of Systematic Reviews and Meta-Analyses

    Following the screening, our 2 investigators extracted all SRs and meta-analyses from each of the included CPGs in the same masked, duplicative fashion. An SR was included if the following three criteria were met: (1) the SR met the definition of an SR as defined by the PRISMA-P (Preferred Reporting Instrument for Systematic Review and Meta-Analysis Protocols) [20]; (2) the SR was available in English; and (3) it was cited in at least 1 of the included CPGs. According to PRISMA-P, “the key characteristics of an SR are (1) a clearly stated set of objectives with an explicit, reproducible methodology; (2) a systematic search that attempts to identify all studies that would meet the eligibility criteria; (3) an assessment of the validity of the findings of the included studies (eg, assessment of risk of bias and confidence in cumulative estimates); and (4) a systematic presentation and synthesis of the characteristics and findings of the included studies” [20]. Of the SRs identified during extraction, a total of 2 were not included due to not meeting the criteria for an SR as stated above.

    Training and Data Extraction

    Before data extraction, investigators underwent several days of training by another investigator (TT). During this training period, investigators received training on AMSTAR and PRISMA appraisal instruments by scoring a sample of SRs according to the instrument’s instructions [21,23]. Next, both investigators discussed the results of the appraisal instruments, and additional training was provided if necessary. In addition to the AMSTAR and PRISMA appraisals, the following study characteristics were extracted from each SR: the year of publication, the population of participants, the interventions used, the number of primary studies comprising the SR, the sample size across all primary studies, and the design of each primary study. Again, all data extractions were conducted in a masked, duplicate fashion. Following data extraction, investigators were unmasked, and disagreements between data sets were resolved through group discussion. If an agreement cannot be reached, a third-party investigator (RO) is available for adjudication.

    PRISMA Checklist

    PRISMA, a 27-item checklist created to increase the quality of reporting in SRs, was developed by an expert panel and scored in accordance with previous studies [5-8]. Each SR received scores based on whether full criteria were met (“yes”=1 point), whether partially met (“partial yes”=0.5 point), or whether no criteria were met (“no”=0 point) for each of the 27 items. Scores were then calculated as a proportion of the criteria met.

    AMSTAR Checklist

    AMSTAR was a 16-item appraisal tool for SRs that contained either randomized or nonrandomized studies concerning health care [23], and assessment scoring was based on previous literature [5-8]. Each of the 16 items will receive a score based on the criteria met. For example, a “yes” was given if the SR met all criteria for that item, a “partial yes” if some but not all criteria were met, and a “no” if criteria were unmet. Each item was assigned a point value according to the PRISMA section. A total of 3 AMSTAR items (11, 12, and 15) are specific to SRs containing meta-analyses and are signified by an “N/A” if the SR contains no meta-analysis. Therefore, all SRs that did not include a meta-analysis were scored against 13 AMSTAR items instead of 16. Each SR receives a final critical appraisal rating of “high,” “moderate,” “low,” or “critically low” according to the AMSTAR calculator [23]. Because the AMSTAR instrument was designed for SRs that investigated a specific intervention, we were unable to appraise these SRs using the AMSTAR instrument [23].

    Secondary Analysis

    A secondary analysis was performed by manually searching the Cochrane database for SRs, cross-referencing, and comparing the Cochrane SRs with SRs included in cutaneous melanoma CPGs.

    Statistical Analysis

    Descriptive statistics were calculated for both PRISMA and AMSTAR completion overall and by item. We used multiple regression to determine relationships between PRISMA completion, AMSTAR appraisal, and extracted study characteristics. Lastly, to evaluate PRISMA and AMSTAR scores between Cochrane SRs and non-Cochrane SRs, a Mann-Whitney U test was used. Stata 16.1 (StataCorp) was used for all statistical analyses.


    General Characteristics

    Our search query returned 4987 possible CPGs, of which 14 CPGs for the treatment of cutaneous melanoma were included (Figure 1). Among the 14 CPGs, 50 SRs were identified in the reference sections, and 28 of these SRs directly underpinned a guideline recommendation (Table 1). The included SRs were published between 2001 and 2018, with 70% (35/50) being published after the 2010 update of the PRISMA reporting criteria (Table 2). Of the 50 SRs, 15 (30%) were focused on diagnostic or imaging techniques, 13 (26%) covered nonsurgical interventions, 5 (10%) covered surgical interventions, and 3 (6%) were focused on both surgical and nonsurgical interventions. A total of 14 (28%) SRs did not involve an intervention. Conflict of interest statements were lacking in 10 (20%) of the 50 SRs, while 16 (32%) did not include a funding statement.

    ‎
    Figure 1. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram of selection process for included clinical practice guidelines (CPGs).
    Table 1. Characteristics of the included clinical practice guidelines (CPGs).
    CPGCharacteristics of the CPG
    Year of publicationSRsa per guideline, nSRs supporting a guideline recommendation, nAverage PRISMAb completion (%)Average AMSTARc completion (%)
    Cutaneous melanoma: ESMOd Clinical Practice Guidelines for diagnosis, treatment, and follow-up [24]2019317036
    The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma [25]2016435430
    Brazilian guidelines for diagnosis, treatment, and follow-up of primary cutaneous melanoma-part II [26]2016635632
    Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition) [27]2015736340
    Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline-Update 2016 [28]2016406442
    Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement [29]2016306725
    Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma [30]2018427251
    Guidelines of care for the management of primary cutaneous melanoma [31]201821146844
    Cutaneous Melanoma, Version 2.2019, NCCNe Clinical Practice Guidelines in Oncology [32]2019306428
    Update on Current Treatment Recommendations for Primary Cutaneous Melanoma [33]2019438162
    Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline [34]2019117762
    Evidence-Based Clinical Practice Guidelines for the Management of Patients with Lentigo Maligna [35]2020337054
    SEOMf clinical guideline for the management of cutaneous melanoma (2020) [36]2021427059
    NCCN Guidelines Insights: Melanoma: Cutaneous, Version 2.2021 [37]2021338366

    aSR: systematic review.

    bPRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

    cAMSTAR: A Measurement Tool to Assess Systematic Reviews.

    dESMO: European Society of Medical Oncology.

    eNCCN: National Comprehensive Cancer Network.

    fSEOM: Spanish Society of Medical Oncology.

    Table 2. Multiple regression analysis showing the percentage of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) completeness for systematic reviews by study characteristics.
    CovariablesSRsa (n=50), n (%)Unadjusted model coefficient (SE)F test (df)2-tailed t testP valueAdjusted model coefficientsb, (SE)Adjusted standardized coefficientsF test (df)2-tailed t testP value
    Year of publicationc3.54 (1, 48)F (12, 23)——
    Before 201015 (30)1 (reference)—d—1 (reference)1 (reference)——
    After 201035 (70)6.96 (3.7)1.88.071.18 (4.09)0.040.29.78
    Intervention type1.70 (4, 45)—
    Diagnostic or imaging technique15 (30)1 (reference)——1 (reference)1 (reference)——
    Nonsurgical13 (26)–9.37 (4.53)–2.07.04–0.07 (4.42)0.00–0.02.99
    No interventionb14 (28)–6.24 (4.44)–1.40.177.42 (7.54)0.140.98.34
    Surgical5 (10)2.54 (6.17)0.41.684.09 (5.01)0.120.82.42
    Surgical and nonsurgical3 (6)–9.35 (7.56)–1.24.22–8.87 (6.99)–0.20–1.27.22
    Conflict of interest3.59 (1, 48)—
    Statement not reported10 (20)1 (reference)——1 (reference)1 (reference)——
    Statement reported40 (80)8.03 (4.24)1.90.060.21 (4.6)0.010.05.97
    Design of included studies0.48 (1, 48)—
    Non-RCTse36 (72)1 (reference)——1 (reference)1 (reference)——
    RCTs14 (28)2.69 (3.89)0.69.491.39 (3.62)0.050.38.70
    AMSTARf ratingb (n=36) 25.06 (2, 33)—
    Critically low19 (53)1 (reference)——1 (reference)1 (reference)——
    Low7 (19)14.43 (3.56)4.05<.00118.07 (4.71)0.583.84<.001
    Moderate10 (28)21.3 (3.15)6.76<.00122.01 (4.56)0.814.83< .001
    High0 (0)——————
    Funding0.03 (3, 46)—
    No funding received12 (24)1 (reference)——1 (reference)1 (reference)——
    No funding statement16 (32)–1.04 (4.84)–0.21.83–3.91 (4.67)–0.14–0.84.41
    Industry2 (4)–2.07 (9.68)–0.21.83–4.67 (11.53)–0.06–0.41.69
    Public or private20 (40)–0.14 (4.63)–0.03.98–0.75 (3.57)–0.03–0.21.84

    aSR: systematic review.

    bA total of 14 articles did not cover interventions; thus, these 14 studies were not able to be assessed by AMSTAR and were excluded from the adjusted analysis.

    c2010 was chosen because PRISMA was first published in 2009.

    dNot available.

    eRCT: randomized controlled trial.

    fAMSTAR: A Measurement Tool to Assess Systematic Reviews.

    PRISMA Completion

    The mean PRISMA completion percentage of SRs was 66.5% (SD 12.3%), ranging from 37% to 89% (Multimedia Appendix 2) [38-86]. Percent completion of SRs per CPG ranged from 54% to 83% complete (Table 1). Multimedia Appendix 3 demonstrates the mean scores for all 27 items included on the PRISMA checklist. A Mann-Whitney U test showed that SRs published after 2010 (mean 68.5%, SD 11.7%) were not significantly better than those published before 2010 (mean 61.6%, SD 12.7%; z=–1.88; P=.06).

    AMSTAR Appraisal

    Of the 50 SRs included, 14 did not cover interventions and, therefore, were unsuitable to be appraised using AMSTAR. Of the 36 remaining SRs, the mean percent completion was 44.6% (SD 21.1%), which ranged from 25% to 65.6% across CPGs (Table 1). Table S3 in Multimedia Appendix 4 demonstrates the mean scores for all items in SRs from the AMSTAR checklist. The methodological quality of these 36 SRs, according to the AMSTAR appraisal, was the following: 19 (53%) were appraised as “critically low” quality; 7 (19%) as “low” quality; 10 (28%) were “moderate” quality; and no SR received a rating of “high” quality (Multimedia Appendix 2).

    Multiple Regression

    We constructed a multiple regression model to assess the relationship between PRISMA completion and the inclusion of a conflicts of interest statement, SR funding, year of publication (pre- or post-2010), intervention type, and AMSTAR rating. This model was statistically significant (F12,23=4.58; P<.001) and accounted for 55.1% of the variance of PRISMA completion. The model showed a statistically significant association between PRISMA completion and AMSTAR appraisals (P<.001), with “low” and “moderate” quality studies being more complete than “critically low” (Table 2).

    Secondary Analysis

    Of the total 50 SRs, 4 (8%) were Cochrane reviews. SRs by the Cochrane group had a mean PRISMA completion of 84.7% (SD 2.1%) compared to 64.9% (SD 11.5%) among non-Cochrane studies (Multimedia Appendix 3)—a statistically significant difference (Mann-Whitney U test z=–3.10; P=.002). Cochrane SRs also had a higher mean AMSTAR completion (mean 86.8%, SD 4.9%) compared to non-Cochrane SRs (mean 40.0%, SD 15.1%; Multimedia Appendix 4). The Mann-Whitney U test also showed this difference to be statistically significant (z=–3.23; P=.001).


    General Findings

    Our findings show that the SRs used in CPGs focused on cutaneous melanoma management vary in methodological and reporting quality, with the majority of guideline recommendations supported by poor-quality SRs. Our findings are consistent with similar studies in the fields of psychiatry, addiction medicine, cardiology, and obesity medicine [5-8]. For example, in 2017, Scott et al [6] found that the quality of SRs used in CPGs for ST-elevated myocardial infarctions was variable and reported a mean PRISMA score similar to ours. No other study in dermatology has explored the quality of SRs underpinning CPGs. However, studies have explored the methodological quality of dermatology-related SRs outside of CPGs [10,87]. In the following paragraphs, we discuss our primary findings, provide recommendations aimed at improving SRs underpinning CPGs, and review the strengths and limitations of this investigation.

    The most concerning findings of this investigation were the overall poor methodological and reporting quality of SRs directly supporting a guideline recommendation, which were not shown to have improved after the publication of the revised PRISMA guidance. In fact, the vast majority of SRs that underpin a recommendation had mean PRISMA scores under 70% and were rated as having critically low methodological quality according to the AMSTAR instrument. An example of a recommendation supported by low-quality evidence can be found in the Spanish Society of Medical Oncology’s (SEOM) clinical guideline for the management of cutaneous melanoma. This guideline provides a recommendation covering positron emission tomography–computerized tomography scans based solely on a SR of low methodological quality and a mean PRISMA score of less than 70%. While the purpose of this study is not to explore the consequences of recommendations supported by poor-quality SRs, it becomes apparent how low-quality evidence supporting recommendations could impact patient care, especially in the management of diseases as dangerous as malignant melanoma.

    All of the Cochrane SRs in our sample received the highest methodological quality and reporting in our sample. This finding is no surprise, as Cochrane SRs are known for their methodological rigor in producing higher-quality, less biased research results [88,89]. Interestingly, and despite the wealth of research supporting the use of Cochrane SRs, only 4 Cochrane SRs were referenced in the 14 CPGs. Additionally, only 1 of these Cochrane SRs was used to support a guideline recommendation directly. As of June 2021, there are 16 available Cochrane SRs related to the management of cutaneous melanoma, of which 4 were used in the 14 CPGs [90].

    An investigation that evaluated the strength of recommendations constituting the AAD CPGs found that the majority of recommendations in this guideline were supported by weak to moderate levels of evidence [13]. Interestingly, in this same study, the authors found that the guideline with the fewest recommendations supported by strong evidence was the melanoma guideline [13]. Despite the amount of weak evidence supporting these guidelines, the problem appears to be the amount of high-quality evidence (such as SRs) in the field of dermatology. For example, a study published in 2021 found that 90% of published dermatology SRs are rated as critically low quality according to the AMSTAR instrument [87]. Similarly, Lin et al [91] found that 60% of SRs focused on atopic dermatitis received an AMSTAR methodological appraisal as either “critically low” or “low,” with only 8.8% of SRs being of “high” quality. Lastly, a study of 136 dermatology-related SRs found that the most underreported PRISMA items were protocol registration and risk of bias [10]—consistent with our findings.

    Recommendations

    In an effort to improve CPGs focused on the management of cutaneous melanoma, we first recommend the use of more Cochrane SRs, as they are of the highest quality compared to non-Cochrane reviews. Next, we advocate that publishing journals update their author guidelines to require PRISMA and AMSTAR completion checklists to be submitted with manuscripts. A previous study found that mandatory PRISMA adherence was associated with improved SR reporting and methodological quality [87,92], which is similar to that found in our investigation. Furthermore, editors and peer reviewers should be provided with these checklists to ensure complete reporting and to provide revisions for improvement. Next, we advocate that journals require authors to register their protocol a priori, as registered reviews are associated with being of higher quality [93]. Finally, we advocate that evidence-based training be provided to physicians and physicians in training that focuses on these quality assessment tools. Providing this education will likely improve the knowledge and skills needed to critically appraise scientific papers included in CPGs [94].

    Strengths and Limitations

    To promote the transparency and reproducibility of this study, we published our protocol on OSF a priori. Additionally, we followed the recommendations outlined in the Cochrane Handbook for Systematic Reviews of Interventions, with both investigators performing all screening and data extraction in a masked, duplicate fashion [95]. However, this study is not without limitations. Unavoidably, the PRISMA and AMSTAR checklists contain some inherent subjectivity. To mitigate subjectivity, investigators were trained before title and abstract screening on the PRISMA and AMSTAR checklists. Additionally, investigators resolved any discrepancies before final data analysis, consulting a third-party arbitrator as necessary. Another limitation of this study is only using PubMed, as it is possible some CPGs focused on the management of cutaneous melanoma could have been missed. A key limitation of this study is that the evaluation of SRs’ methodical quality does not take into account the specific needs of a CPG or whether or not the SR is relevant to the CPG. Lastly, our appraisal of SRs used the AMSTAR checklist published in 2017. Therefore, all SRs published before 2017 were only able to use the original AMSTAR checklist before publication.

    Conclusions

    Our investigation found that CPGs focused on the management of cutaneous melanoma are supported by SRs that frequently underreport PRISMA items and are of critically low to low methodological quality. Additionally, we found that Cochrane SRs are of higher quality compared to non-Cochrane SRs. Future research should focus on methods to increase PRISMA and AMSTAR adherence, as doing so results in higher-quality SRs.

    Conflicts of Interest

    MV reports receipt of funding from the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, the US Office of Research Integrity, the Oklahoma Center for Advancement of Science and Technology, and internal grants from the Oklahoma State University Center for Health Sciences—all outside of the present work. MH reports funding from the National Institutes of Justice for unrelated work.

    Multimedia Appendix 1

    Study protocol.

    DOCX File , 22 KB
    Multimedia Appendix 2

    Quality of systematic reviews included in clinical practice guidelines (CPGs).

    DOCX File , 28 KB
    Multimedia Appendix 3

    PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) completeness summary for the systematic reviews comprising the 14 guidelines for the management of cutaneous melanoma.

    DOCX File , 35 KB
    Multimedia Appendix 4

    Summary of AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) completeness scores across the 5 included guidelines.

    DOCX File , 31 KB
    1. Kredo T, Bernhardsson S, Machingaidze S, Young T, Louw Q, Ochodo E, et al. Guide to clinical practice guidelines: the current state of play. Int J Qual Health Care. Feb 2016;28(1):122-128. [FREE Full text] [CrossRef] [Medline]
    2. Murad MH. Clinical practice guidelines: a primer on development and dissemination. Mayo Clin Proc. Mar 2017;92(3):423-433. [FREE Full text] [CrossRef] [Medline]
    3. Wakkee M, Lugtenberg M, Spuls PI, de Jong EM, Thio HB, Westert GP, et al. Knowledge, attitudes and use of the guidelines for the treatment of moderate to severe plaque psoriasis among Dutch dermatologists. Br J Dermatol. Aug 2008;159(2):426-432. [CrossRef] [Medline]
    4. Taba P, Rosenthal M, Habicht J, Tarien H, Mathiesen M, Hill S, et al. Barriers and facilitators to the implementation of clinical practice guidelines: a cross-sectional survey among physicians in Estonia. BMC Health Serv Res. Dec 13, 2012;12:455. [FREE Full text] [CrossRef] [Medline]
    5. Aran G, Hicks C, Demand A, Johnson AL, Beaman J, Bailey Y, et al. Treating schizophrenia: the quality of evidence behind treatment recommendations and how it can improve. BMJ Evid Based Med. Aug 2020;25(4):138-142. [CrossRef] [Medline]
    6. Scott J, Howard B, Sinnett P, Schiesel M, Baker J, Henderson P, et al. Variable methodological quality and use found in systematic reviews referenced in STEMI clinical practice guidelines. Am J Emerg Med. Dec 2017;35(12):1828-1835. [CrossRef] [Medline]
    7. Nissen T, Wayant C, Wahlstrom A, Sinnett P, Fugate C, Herrington J, et al. Methodological quality, completeness of reporting and use of systematic reviews as evidence in clinical practice guidelines for paediatric overweight and obesity. Clin Obes. Feb 2017;7(1):34-45. [CrossRef] [Medline]
    8. Ross A, Rankin J, Beaman J, Murray K, Sinnett P, Riddle R, et al. Methodological quality of systematic reviews referenced in clinical practice guidelines for the treatment of opioid use disorder. PLoS One. 2017;12(8):e0181927. [FREE Full text] [CrossRef] [Medline]
    9. Werner RN, Marinović B, Rosumeck S, Strohal R, Haering NS, Weberschock T, et al. The quality of European dermatological guidelines: critical appraisal of the quality of EDF guidelines using the AGREE II instrument. J Eur Acad Dermatol Venereol. Mar 2016;30(3):395-403. [FREE Full text] [CrossRef] [Medline]
    10. Croitoru DO, Huang Y, Kurdina A, Chan AW, Drucker AM. Quality of reporting in systematic reviews published in dermatology journals. Br J Dermatol. Jun 2020;182(6):1469-1476. [CrossRef] [Medline]
    11. Steeb T, Wessely A, Drexler K, Salzmann M, Toussaint F, Heinzerling L, et al. The quality of practice guidelines for melanoma: a methodologic appraisal with the AGREE II and AGREE-REX instruments. Cancers (Basel). Jun 18, 2020;12(6):1613-1625. [FREE Full text] [CrossRef] [Medline]
    12. Lunny C, Ramasubbu C, Puil L, Liu T, Gerrish S, Salzwedel DM, et al. Over half of clinical practice guidelines use non-systematic methods to inform recommendations: a methods study. PLoS One. 2021;16(4):e0250356. [FREE Full text] [CrossRef] [Medline]
    13. Cook C, Ottwell R, Rogers T, Checketts J, Musuvathy S, Vassar M. Evaluation of the level of evidence supporting the recommendations constituting the American Academy of Dermatology clinical practice guidelines: cross-sectional analysis. JMIR Dermatol. 2020;3(1):e17370. [FREE Full text] [CrossRef]
    14. Williams HC, Dellavalle RP. The growth of clinical trials and systematic reviews in informing dermatological patient care. J Invest Dermatol. Mar 2012;132(3 Pt 2):1008-1017. [FREE Full text] [CrossRef] [Medline]
    15. Flohr C, Abuabara K, Bath-Hextall F, Nast A, van Zuuren E. Introducing the new evidence-based dermatology section. Br J Dermatol. Oct 2017;177(4):885-887. [CrossRef] [Medline]
    16. Niforatos JD, Weaver M, Johansen ME. Assessment of publication trends of systematic reviews and randomized clinical trials, 1995 to 2017. JAMA Intern Med. Nov 01, 2019;179(11):1593-1594. [FREE Full text] [CrossRef] [Medline]
    17. Melanoma Protocol. OSF. URL: https://osf.io/s84wq/?view_only= [accessed 2023-09-19]
    18. Strings attached: CADTH's database search filters. Canadian Agency for Drugs and Technologies in Health. 2014. URL: https://searchfilters.cadth.ca/ [accessed 2021-01-10]
    19. Institute of Medicine; Board on Health Care Services; Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. In: Wolman DM, Steinberg E, Mancher M, Graham R, Greenfield S, editors. Clinical Practice Guidelines We Can Trust. Washington, D.C. National Academies Press; 2011.
    20. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. Jan 02, 2015;350:g7647. [FREE Full text] [CrossRef] [Medline]
    21. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JPA, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. Jul 21, 2009;6(7):e1000100. [FREE Full text] [CrossRef] [Medline]
    22. American Society of Clinical Oncology. URL: https://www.asco.org/ [accessed 2021-05-21]
    23. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. Sep 21, 2017;358:j4008. [FREE Full text] [CrossRef] [Medline]
    24. Michielin O, van Akkooi ACJ, Ascierto PA, Dummer R, Keilholz U, ESMO Guidelines Committee. Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol. 2019;30(12):1884-1901. [FREE Full text] [CrossRef] [Medline]
    25. Dummer R, Siano M, Hunger RE, Lindenblatt N, Braun R, Michielin O, et al. The updated Swiss guidelines 2016 for the treatment and follow-up of cutaneous melanoma. Swiss Med Wkly. 2016;146:w14279. [FREE Full text] [CrossRef] [Medline]
    26. Castro LGM, Bakos RM, Duprat Neto JP, Bittencourt FV, Di Giacomo THB, Serpa SS, et al. Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II. An Bras Dermatol. 2016;91(1):49-58. [FREE Full text] [CrossRef] [Medline]
    27. Guo J, Qin S, Liang J, Lin T, Si L, Chen X, et al. Chinese Guidelines on the Diagnosis and Treatment of Melanoma (2015 Edition). Ann Transl Med. 2015;3(21):322. [FREE Full text] [CrossRef] [Medline]
    28. Garbe C, Peris K, Hauschild A, Saiag P, Middleton M, Bastholt L, et al. Diagnosis and treatment of melanoma. European consensus-based interdisciplinary guideline - update 2016. Eur J Cancer. 2016;63:201-217. [CrossRef] [Medline]
    29. Mangione CM, Barry MJ, Nicholson WK, Chelmow D, Coker TR, Davis EM, et al. Screening for skin cancer: US Preventive Services Task Force recommendation statement. JAMA. 2023;329(15):1290-1295. [CrossRef] [Medline]
    30. Sladden MJ, Nieweg OE, Howle J, Coventry BJ, Thompson JF. Updated evidence-based clinical practice guidelines for the diagnosis and management of melanoma: definitive excision margins for primary cutaneous melanoma. Med J Aust. 2018;208(3):137-142. [CrossRef] [Medline]
    31. Swetter SM, Tsao H, Bichakjian CK, Curiel-Lewandrowski C, Elder DE, Gershenwald JE, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019;80(1):208-250. [CrossRef] [Medline]
    32. Coit DG, Thompson JA, Albertini MR, Barker C, Carson WE, Contreras C, et al. Cutaneous melanoma, version 2.2019, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2019;17(4):367-402. [CrossRef] [Medline]
    33. Dowling J, McGregor SP, Williford P. Update on current treatment recommendations for primary cutaneous melanoma. Dermatol Clin. 2019;37(4):397-407. [CrossRef] [Medline]
    34. Wright FC, Souter LH, Kellett S, Easson A, Murray C, Toye J, et al. Primary excision margins, sentinel lymph node biopsy, and completion lymph node dissection in cutaneous melanoma: a clinical practice guideline. Curr Oncol. 2019;26(4):e541-e550. [FREE Full text] [CrossRef] [Medline]
    35. Robinson M, Primiero C, Guitera P, Hong A, Scolyer RA, Stretch JR, et al. Evidence-based clinical practice guidelines for the management of patients with lentigo maligna. Dermatology. 2020;236(2):111-116. [FREE Full text] [CrossRef] [Medline]
    36. Majem M, Manzano JL, Marquez-Rodas I, Mujika K, Muñoz-Couselo E, Pérez-Ruiz E, et al. SEOM clinical guideline for the management of cutaneous melanoma (2020). Clin Transl Oncol. 2021;23(5):948-960. [FREE Full text] [CrossRef] [Medline]
    37. Swetter SM, Thompson JA, Albertini MR, Barker CA, Baumgartner J, Boland G, et al. NCCN guidelines insights: melanoma: cutaneous, version 2.2021. J Natl Compr Canc Netw. 2021;19(4):364-376. [CrossRef] [Medline]
    38. Chen SC, Bravata DM, Weil E, Olkin I. A comparison of dermatologists' and primary care physicians' accuracy in diagnosing melanoma: a systematic review. Arch Dermatol. 2001;137(12):1627-1634. [CrossRef] [Medline]
    39. Lens MB, Dawes M, Goodacre T, Bishop JAN. Excision margins in the treatment of primary cutaneous melanoma: a systematic review of randomized controlled trials comparing narrow vs wide excision. Arch Surg. 2002;137(10):1101-1105. [CrossRef] [Medline]
    40. Haigh PI, DiFronzo LA, McCready DR. Optimal excision margins for primary cutaneous melanoma: a systematic review and meta-analysis. Can J Surg. 2003;46(6):419-426. [FREE Full text] [Medline]
    41. Bafounta ML, Beauchet A, Chagnon S, Saiag P. Ultrasonography or palpation for detection of melanoma nodal invasion: a meta-analysis. Lancet Oncol. 2004;5(11):673-680. [CrossRef] [Medline]
    42. Mocellin S, Hoon DSB, Pilati P, Rossi CR, Nitti D. Sentinel lymph node molecular ultrastaging in patients with melanoma: a systematic review and meta-analysis of prognosis. J Clin Oncol. 2007;25(12):1588-1595. [CrossRef] [Medline]
    43. Ives J, Stowe RL, Lorigan P, Wheatley K. Chemotherapy compared with biochemotherapy for the treatment of metastatic melanoma: a meta-analysis of 18 trials involving 2,621 patients. J Clin Oncol. 2007;25(34):5426-5434. [CrossRef] [Medline]
    44. Hamm C, Verma S, Petrella T, Bak K, Charette M, Melanoma Disease Site Group of Cancer Care Ontario's Program in Evidence-based Care. Biochemotherapy for the treatment of metastatic malignant melanoma: a systematic review. Cancer Treat Rev. 2008;34(2):145-156. [CrossRef] [Medline]
    45. Mocellin S, Zavagno G, Nitti D. The prognostic value of serum S100B in patients with cutaneous melanoma: a meta-analysis. Int J Cancer. 2008;123(10):2370-2376. [FREE Full text] [CrossRef] [Medline]
    46. Krug B, Crott R, Lonneux M, Baurain JF, Pirson AS, Vander Borght T. Role of PET in the initial staging of cutaneous malignant melanoma: systematic review. Radiology. 2008;249(3):836-844. [CrossRef] [Medline]
    47. Rajpara SM, Botello AP, Townend J, Ormerod AD. Systematic review of dermoscopy and digital dermoscopy/ artificial intelligence for the diagnosis of melanoma. Br J Dermatol. 2009;161(3):591-604. [CrossRef] [Medline]
    48. Sladden MJ, Balch C, Barzilai DA, Berg D, Freiman A, Handiside T, et al. Surgical excision margins for primary cutaneous melanoma. Cochrane Database Syst Rev. 2009(4):CD004835. [CrossRef] [Medline]
    49. Mocellin S, Pasquali S, Rossi CR, Nitti D. Interferon alpha adjuvant therapy in patients with high-risk melanoma: a systematic review and meta-analysis. J Natl Cancer Inst. 2010;102(7):493-501. [CrossRef] [Medline]
    50. Xing Y, Bronstein Y, Ross MI, Askew RL, Lee JE, Gershenwald JE, et al. Contemporary diagnostic imaging modalities for the staging and surveillance of melanoma patients: a meta-analysis. J Natl Cancer Inst. 2011;103(2):129-142. [FREE Full text] [CrossRef] [Medline]
    51. Garbe C, Eigentler TK, Keilholz U, Hauschild A, Kirkwood JM. Systematic review of medical treatment in melanoma: current status and future prospects. Oncologist. 2011;16(1):5-24. [FREE Full text] [CrossRef] [Medline]
    52. Valsecchi ME, Silbermins D, de Rosa N, Wong SL, Lyman GH. Lymphatic mapping and sentinel lymph node biopsy in patients with melanoma: a meta-analysis. J Clin Oncol. 2011;29(11):1479-1487. [CrossRef] [Medline]
    53. de Rosa N, Lyman GH, Silbermins D, Valsecchi ME, Pruitt SK, Tyler DM, et al. Sentinel node biopsy for head and neck melanoma: a systematic review. Otolaryngol Head Neck Surg. 2011;145(3):375-382. [CrossRef] [Medline]
    54. Petrella T, Verma S, Spithoff K, Quirt I, McCready D, Melanoma Disease Site Group. Adjuvant interferon therapy for patients at high risk for recurrent melanoma: an updated systematic review and practice guideline. Clin Oncol (R Coll Radiol). 2012;24(6):413-423. [CrossRef] [Medline]
    55. Cromwell KD, Ross MI, Xing Y, Gershenwald JE, Royal RE, Lucci A, et al. Variability in melanoma post-treatment surveillance practices by country and physician specialty: a systematic review. Melanoma Res. 2012;22(5):376-385. [FREE Full text] [CrossRef] [Medline]
    56. Vourc'h-Jourdain M, Martin L, Barbarot S, aRED. Large congenital melanocytic nevi: therapeutic management and melanoma risk: a systematic review. J Am Acad Dermatol. 2013;68(3):493-8.e1. [CrossRef] [Medline]
    57. Schröer-Günther MA, Wolff RF, Westwood ME, Scheibler FJ, Schürmann C, Baumert BG, et al. F-18-fluoro-2-deoxyglucose positron emission tomography (PET) and PET/computed tomography imaging in primary staging of patients with malignant melanoma: a systematic review. Syst Rev. 2012;1:62. [FREE Full text] [CrossRef] [Medline]
    58. Minkis K, Garden BC, Wu S, Pulitzer MP, Lacouture ME. The risk of rash associated with ipilimumab in patients with cancer: a systematic review of the literature and meta-analysis. J Am Acad Dermatol. 2013;69(3):e121-e128. [CrossRef] [Medline]
    59. Stevenson AD, Mickan S, Mallett S, Ayya M. Systematic review of diagnostic accuracy of reflectance confocal microscopy for melanoma diagnosis in patients with clinically equivocal skin lesions. Dermatol Pract Concept. 2013;3(4):19-27. [FREE Full text] [CrossRef] [Medline]
    60. Flaherty KT, Hennig M, Lee SJ, Ascierto PA, Dummer R, Eggermont AMM, et al. Surrogate endpoints for overall survival in metastatic melanoma: a meta-analysis of randomised controlled trials. Lancet Oncol. 2014;15(3):297-304. [FREE Full text] [CrossRef] [Medline]
    61. Matsuda A, Miyashita M, Matsumoto S, Takahashi G, Matsutani T, Yamada T, et al. Abdominoperineal resection provides better local control but equivalent overall survival to local excision of anorectal malignant melanoma: a systematic review. Ann Surg. 2015;261(4):670-677. [CrossRef] [Medline]
    62. Kyrgidis A, Tzellos T, Mocellin S, Apalla Z, Lallas A, Pilati P, et al. Sentinel lymph node biopsy followed by lymph node dissection for localised primary cutaneous melanoma. Cochrane Database Syst Rev. 2015;2015(5):CD010307. [FREE Full text] [CrossRef] [Medline]
    63. Mora AN, Karia PS, Nguyen BM. A quantitative systematic review of the efficacy of imiquimod monotherapy for lentigo maligna and an analysis of factors that affect tumor clearance. J Am Acad Dermatol. 2015;73(2):205-212. [CrossRef] [Medline]
    64. Read T, Noonan C, David M, Wagels M, Foote M, Schaider H, et al. A systematic review of non-surgical treatments for lentigo maligna. J Eur Acad Dermatol Venereol. 2016;30(5):748-753. [CrossRef] [Medline]
    65. Bertrand A, Kostine M, Barnetche T, Truchetet ME, Schaeverbeke T. Immune related adverse events associated with anti-CTLA-4 antibodies: systematic review and meta-analysis. BMC Med. 2015;13:211. [FREE Full text] [CrossRef] [Medline]
    66. Wheatley K, Wilson JS, Gaunt P, Marsden JR. Surgical excision margins in primary cutaneous melanoma: a meta-analysis and Bayesian probability evaluation. Cancer Treat Rev. 2016;42:73-81. [CrossRef] [Medline]
    67. Cordeiro E, Gervais MK, Shah PS, Look Hong NJ, Wright FC. Sentinel lymph node biopsy in thin cutaneous melanoma: a systematic review and meta-analysis. Ann Surg Oncol. 2016;23(13):4178-4188. [CrossRef] [Medline]
    68. Abdel-Wahab N, Shah M, Suarez-Almazor ME. Adverse events associated with immune checkpoint blockade in patients with cancer: a systematic review of case reports. PLoS One. 2016;11(7):e0160221. [FREE Full text] [CrossRef] [Medline]
    69. Tio D, van der Woude J, Prinsen CAC, Jansma EP, Hoekzema R, van Montfrans C. A systematic review on the role of imiquimod in lentigo maligna and lentigo maligna melanoma: need for standardization of treatment schedule and outcome measures. J Eur Acad Dermatol Venereol. 2017;31(4):616-624. [CrossRef] [Medline]
    70. Ives NJ, Suciu S, Eggermont AMM, Kirkwood J, Lorigan P, Markovic SN, et al. Adjuvant interferon-α for the treatment of high-risk melanoma: an individual patient data meta-analysis. Eur J Cancer. 2017;82:171-183. [FREE Full text] [CrossRef] [Medline]
    71. Wang DY, Salem JE, Cohen JV, Chandra S, Menzer C, Ye F, et al. Fatal toxic effects associated with immune checkpoint inhibitors: a systematic review and meta-analysis. JAMA Oncol. 2018;4(12):1721-1728. [FREE Full text] [CrossRef] [Medline]
    72. Dinnes J, Deeks JJ, Saleh D, Chuchu N, Bayliss SE, Patel L, et al. Reflectance confocal microscopy for diagnosing cutaneous melanoma in adults. Cochrane Database Syst Rev. 2018;12(12):CD013190. [FREE Full text] [CrossRef] [Medline]
    73. Watt AJ, Kotsis SV, Chung KC. Risk of melanoma arising in large congenital melanocytic nevi: a systematic review. Plast Reconstr Surg. 2004;113(7):1968-1974. [CrossRef] [Medline]
    74. Gandini S, Sera F, Cattaruzza MS, Pasquini P, Abeni D, Boyle P, et al. Meta-analysis of risk factors for cutaneous melanoma: I. Common and atypical naevi. Eur J Cancer. 2005;41(1):28-44. [FREE Full text] [CrossRef] [Medline]
    75. Gandini S, Sera F, Cattaruzza MS, Pasquini P, Zanetti R, Masini C, et al. Meta-analysis of risk factors for cutaneous melanoma: III. Family history, actinic damage and phenotypic factors. Eur J Cancer. 2005;41(14):2040-2059. [CrossRef] [Medline]
    76. Krengel S, Hauschild A, Schäfer T. Melanoma risk in congenital melanocytic naevi: a systematic review. Br J Dermatol. 2006;155(1):1-8. [CrossRef] [Medline]
    77. Gandini S, Iodice S, Koomen E, Di Pietro A, Sera F, Caini S. Hormonal and reproductive factors in relation to melanoma in women: current review and meta-analysis. Eur J Cancer. 2011;47(17):2607-2617. [CrossRef] [Medline]
    78. Ensslin CJ, Rosen AC, Wu S, Lacouture ME. Pruritus in patients treated with targeted cancer therapies: systematic review and meta-analysis. J Am Acad Dermatol. 2013;69(5):708-720. [FREE Full text] [CrossRef] [Medline]
    79. Vuong K, McGeechan K, Armstrong BK, Cust AE. Risk prediction models for incident primary cutaneous melanoma: a systematic review. JAMA Dermatol. 2014;150(4):434-444. [CrossRef] [Medline]
    80. Caini S, Boniol M, Botteri E, Tosti G, Bazolli B, Russell-Edu W, et al. The risk of developing a second primary cancer in melanoma patients: a comprehensive review of the literature and meta-analysis. J Dermatol Sci. 2014;75(1):3-9. [CrossRef] [Medline]
    81. Teulings HE, Limpens J, Jansen SN, Zwinderman AH, Reitsma JB, Spuls PI, et al. Vitiligo-like depigmentation in patients with stage III-IV melanoma receiving immunotherapy and its association with survival: a systematic review and meta-analysis. J Clin Oncol. 2015;33(7):773-781. [CrossRef] [Medline]
    82. Byrom L, Olsen C, Knight L, Khosrotehrani K, Green AC. Increased mortality for pregnancy-associated melanoma: systematic review and meta-analysis. J Eur Acad Dermatol Venereol. 2015;29(8):1457-1466. [CrossRef] [Medline]
    83. Byrom L, Olsen CM, Knight L, Khosrotehrani K, Green AC. Does pregnancy after a diagnosis of melanoma affect prognosis? Systematic review and meta-analysis. Dermatol Surg. 2015;41(8):875-882. [CrossRef] [Medline]
    84. Ribero S, Gualano MR, Osella-Abate S, Scaioli G, Bert F, Sanlorenzo M, et al. Association of histologic regression in primary melanoma with sentinel lymph node status: a systematic review and meta-analysis. JAMA Dermatol. 2015;151(12):1301-1307. [CrossRef] [Medline]
    85. Wernli KJ, Henrikson NB, Morrison CC, Nguyen M, Pocobelli G, Blasi PR. Screening for skin cancer in adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2016;316(4):436-447. [CrossRef] [Medline]
    86. Gualano MR, Osella-Abate S, Scaioli G, Marra E, Bert F, Faure E, et al. Prognostic role of histological regression in primary cutaneous melanoma: a systematic review and meta-analysis. Br J Dermatol. 2018;178(2):357-362. [FREE Full text] [CrossRef] [Medline]
    87. Smires S, Afach S, Mazaud C, Phan C, Garcia Doval I, Boyle R, et al. Quality and reporting completeness of systematic reviews and meta-analyses in dermatology. J Invest Dermatol. Jan 2021;141(1):64-71. [FREE Full text] [CrossRef] [Medline]
    88. Useem J, Brennan A, LaValley M, Vickery M, Ameli O, Reinen N, et al. Systematic differences between Cochrane and non-Cochrane meta-analyses on the same topic: a matched pair analysis. PLoS One. 2015;10(12):e0144980. [FREE Full text] [CrossRef] [Medline]
    89. Petticrew M, Wilson P, Wright K, Song F. Quality of Cochrane reviews. quality of Cochrane reviews is better than that of non-Cochrane reviews. BMJ. Mar 02, 2002;324(7336):545. [FREE Full text] [CrossRef] [Medline]
    90. Our reviews. Cochrane Skin. URL: https://skin.cochrane.org/our-evidence [accessed 2021-06-27]
    91. Lin V, Patel R, Wirtz A, Mannem D, Ottwell R, Arthur W, et al. Evaluation of spin in the abstracts of systematic reviews and meta-analyses of atopic dermatitis treatments and interventions. Dermatology. May 17, 2021;237(4):496-505. [CrossRef] [Medline]
    92. Panic N, Leoncini E, de Belvis G, Ricciardi W, Boccia S. Evaluation of the endorsement of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement on the quality of published systematic review and meta-analyses. PLoS One. 2013;8(12):e83138. [FREE Full text] [CrossRef] [Medline]
    93. Sideri S, Papageorgiou SN, Eliades T. Registration in the International Prospective Register of Systematic Reviews (PROSPERO) of systematic review protocols was associated with increased review quality. J Clin Epidemiol. Aug 2018;100:103-110. [FREE Full text] [CrossRef] [Medline]
    94. Hecht L, Buhse S, Meyer G. Effectiveness of training in evidence-based medicine skills for healthcare professionals: a systematic review. BMC Med Educ. Apr 04, 2016;16:103. [FREE Full text] [CrossRef] [Medline]
    95. Higgins J, Thomas J, Chandler J, Page MJ, Cumpston M, Li T, et al. Cochrane Handbook for Systematic Reviews of Interventions, Second Edition. Hoboken, NJ. Wiley-Blackwell; 2019.

    ‎
    AAD: American Academy of Dermatology
    AGREE II: Appraisal of Guidelines for Research and Evaluation Instrument
    AMSTAR: A Measurement Tool to Assess Systematic Reviews
    CPG: clinical practice guideline
    OSF: Open Science Framework
    PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses
    PRISMA-P: Preferred Reporting Instrument for Systematic Review and Meta-Analysis Protocols
    QCRI: Qatar Computing Research Institute
    SEOM: Spanish Society of Medical Oncology
    SR: systematic review

    Edited by R Dellavalle; submitted 27.10.22; peer-reviewed by H Baradaran, WD Dotson; comments to author 01.02.23; revised version received 28.03.23; accepted 15.09.23; published 07.12.23.

    Copyright

    ©Mahnoor Khalid, Bethany Sutterfield, Kirstien Minley, Ryan Ottwell, McKenna Abercrombie, Christopher Heath, Trevor Torgerson, Micah Hartwell, Matt Vassar. Originally published in JMIR Dermatology (http://derma.jmir.org), 07.12.2023.

    This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Dermatology, is properly cited. The complete bibliographic information, a link to the original publication on http://derma.jmir.org, as well as this copyright and license information must be included.