Jolliffe 2001a.

Study characteristics
Patient sampling	Study design: case series Data collection: prospective Period of data collection: NR Country: UK
Patient characteristics and setting	Inclusion criteria: people referred by their GP for dermatological assessment of a pigmented lesion at the PLC Setting: specialist unit (skin cancer/pigmented lesions clinic) Prior testing: not explicitly mention but most likely clinical examination Setting for prior testing: primary Sample size (participants): number eligible: 138; number included: 138 Sample size (lesions): number eligible: 144; number included: 144; clinical diagnosis 140; teledermoscopy Participant characteristics: Age: range 15–94 years Gender: male: 48 (34%); female 90 (66%) Lesion characteristics: NR
Index tests	In‐person FTF clinical assessment Method of diagnosis: at the PLC a clinical diagnosis (± the use of dermoscopy) based upon information in the referral letter and examination findings was made and recorded by the examining doctor Prior test data: clinical examination or case notes (or both) Diagnostic threshold: NR Diagnosis based on: single Number of examiners: 1 Observer qualifications: dermatologist Experience in practice: unclear Experience with index test: unclear TD Acquisition and transmission of images: the examining doctor using a single chip video camera, obtained an image of the pigmented lesion. The image was then archived using proprietary software and images were transmitted through a Fast Screen Machine 2 video overlay card and viewed on a 15 inch monitor. Nature of images used: clinical Any additional participant information provided: clinical examination or case notes (or both) Observer qualifications (remote diagnosis): dermatologist Diagnosis based on: single observer Number of observers: 1 Method of diagnosis: the anonymous video images and the GP's referral letter were then viewed several months later by the same doctor who performed the in‐person assessment and a diagnosis made. Management options: NR
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Lesions had been excised either to confirm or refute clinical suspicion of malignancy or atypia. No participant had a lesion removed on account of the study Target condition (final diagnoses) Malignant: melanoma (in situ and invasive, or NR): 2; Lentigo maligna: 2; BCC: 9. Benign diagnoses: atypical naevus: 5; benign melanocytic naevus: 89; SK: 9; solar lentigo: 7; blue naevus: 4; freckle: 2; SN: 2; dermoid cyst: 2; pyogenic granuloma: 2; congenital naevus: 1; naevus sebaceous: 1; DF: 1; haemangioma: 1; abscess: 1; nodular hidradenoma: 1; non‐caseating granuloma: 1; apocrine hidrocystoma: 1; angiokeratoma circumscriptum: 1
Flow and timing	Excluded participants: in 4 cases it was impossible to make a diagnosis from the image, due to poor image quality. Time interval to reference test: NR Time interval between index test(s): the same doctor viewed the images several months after examining the participant in clinic.
Comparative	The anonymous video images and the GP's referral letter were then viewed several months later by the same doctor and a diagnosis made. The same doctor who performed the clinical examination viewed the images. The doctor's potential memory of a lesion may, therefore, be perceived to be a source of bias. In reality, > 800 pigmented lesions had been seen by this doctor between the in‐person and video examinations, making memory of a specific lesion less likely.
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?	No
Did the study avoid including participants with multiple lesions?	Yes
		Unclear	High
DOMAIN 2: Index Test Teledermatology
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
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?	Unclear
Was the test interpretation carried out by an experienced examiner?	Unclear
		Low	High
DOMAIN 2: Index Test FTF diagnosis
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
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?	Unclear
Was the test interpretation carried out by an experienced examiner?	Yes
		Unclear	Unclear
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
For studies comparing TD/FTF clinical diagnosis to histology, was histology interpretation carried out by an experienced histopathologist or by a dermatopathologist?	Unclear
For studies comparing TD to FTF diagnosis, was the clinical diagnosis carried out by an experienced observer?
		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?	No
If the reference standard includes clinical FU of borderline/benign appearing lesions, was there a minimum FU following application of index test(s) of at least: 3 months for melanoma or cSCC or 6 months for BCC?
		High
DOMAIN 5: Comparative
Was each index test result interpreted without knowledge of the results of other index tests or testing strategies?	Unclear
Was the interval between application of the index tests less than 1 month?	No
Were all tests applied and interpreted in a clinically applicable manner?	No
		High	High