Troyanova 2003.

Study characteristics
Patient sampling	Study design: CCS Data collection: retrospective image selection/prospective interpretation Period of data collection: NR Country: NR
Patient characteristics and setting	Inclusion criteria: Images of PSLs ≤ 13 mm in diameter selected for a dermoscopy training study Setting: training study Prior testing: NR Setting for prior testing: NR Exclusion criteria: NR Sample size (participants): NR Sample size (lesions): number included: 50 lesions Participant characteristics: NR Lesion characteristics: melanoma thickness: ≤ 1 mm: 100%
Index tests	VI: no algorithm Method of diagnosis: clinical photographs and dermoscopic images Other test data: dermoscopic images presented to observer subsequent to diagnosis using clinical images alone. Prior test data: no further information used Diagnostic threshold: NR Diagnosis based on: average; n = 32 Observer qualifications: dermatologist Experience in practice: high experience or ‘Expert’ Experience with index test: low experience/novice users; experienced in PSL field but not ELM Dermoscopy: evaluated in same study; no algorithm
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Disease positive: 25; disease negative: 25 Target condition (final diagnoses) Melanoma (in situ and invasive, or NR): 25 'Benign' diagnoses: 25 "not melanoma"
Flow and timing	Excluded participants: none reported Time interval to reference test: NR Time interval between index test(s): 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?	No
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?	Unclear
		High	High
DOMAIN 2: Index Test Visual inspection ‐ 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?	No
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