Soyer 1995.

Study characteristics
Patient sampling	Study design: CS Data collection: unclear Period of data collection: NR Country: Austria
Patient characteristics and setting	Inclusion criteria: PSL, difficult to diagnose on clinical grounds alone Setting: specialist unit (skin cancer clinic/PLC) Prior testing: clinical suspicion Setting for prior testing: secondary (general dermatology); referred by dermatologists or general physicians Exclusion criteria: none reported Sample size (participants): NR Sample size (lesions): number included: 159 Participant characteristics: none reported Lesion characteristics "23 melanomas with a Breslow index of ≤ 0.75 mm, 13 melanomas with a Breslow index ≥ 0.76 mm and ≤ 1.5 mm, 12 melanomas with a Breslow index ≥ 1.51 mm and ≤ 3.5 mm, 2 melanomas with a Breslow index of ≥ 3.5 mm."
Index tests	VI: no algorithm Method of diagnosis: in‐person diagnosis Prior test data: N/A in‐person diagnosis Other test data: dermoscopy undertaken by same clinician(s) subsequent to clinical evaluation Diagnostic threshold: NR Diagnosis based on: n = 2 (1 or 2 per lesion) Observer qualifications: dermatologist Experience in practice: not clearly described; assumed to be high; “Each lesion was examined clinically by .. one of the authors .. and a clinical diagnosis was recorded.” “After application of a drop of immersion oil, each lesion was examined dermoscopically …; the examination was performed by a dermatologist expert in dermoscopy and a dermoscopic diagnosis was recorded” Experience with index test: not described Other detail: "Photographic documentation was performed using an incident light stereomicroscope (Wild M 650) equipped with a Minolta XG‐M camera" Dermoscopy: evaluated in same study; pattern analysis
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Disease positive: 65 (41%); disease negative: 94 (59%) Target condition (final diagnoses) Melanoma (invasive): 50; melanoma (in situ): 15 BCC: pigmented BCC (3) SK: 18; Clark's naevus of dysplastic naevus (61 cases); lentigo actinica lentigo (2), pigmented AK (4), angioma (3), angiokeratoma (2)
Flow and timing	Excluded participants: none reported 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?	Unclear
Did the study avoid including participants with multiple lesions?	Unclear
		Unclear	Unclear
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?	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?	Unclear
		Low	Unclear
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