Dummer 1993.

Study characteristics
Patient sampling	Study design: case series Data collection: prospective; dermoscopic images assessed remotely from the patient Period of data collection: 12 month period (year/dates NR) Country: Germany
Patient characteristics and setting	Inclusion criteria: patients with skin lesions difficult to diagnose clinically Setting: secondary Prior testing: clinical suspicion of malignancy without dermatoscopic suspicion Setting for prior testing: specialist unit (skin cancer/PLC) a type of specialist care‐ dermatology based clinic Exclusion criteria: patients who had excisions performed in individual practices or where there was no histology or cases that were so obvious they didn't need to have further investigation (clearly benign) Sample size (participants): NR Sample size (lesions): number eligible: 824; number included: 771 Participant characteristics: none reported Lesion characteristics: none reported
Index tests	VI: no algorithm Method of diagnosis: in person Prior test data: in person Other test data: dermoscopic images viewed separately Diagnostic threshold: NR Diagnosis based on: single observer; (n = 2 or 3) Observer qualifications: unclear; clinician based in dermatology clinic (assumed dermatologist) Experience in practice: unclear Experience with index test: unclear Dermoscopy: pattern analysis Method of diagnosis: dermoscopic images Prior test data: unclear Diagnostic threshold: NR Observers: as described above
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Disease‐positive: 23 MM; disease‐negative: 748 benign Target condition (final diagnoses) Invasive melanoma: 23 Benign naevus 706; SK 4; benign non‐melanocytic naevus 32
Flow and timing	Excluded participants: 53 non‐melanocytic lesions not included in the final analysis (no melanomas present in this group) 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?	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?	Unclear
		Unclear	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?
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?	Unclear
		Low	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?	No
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?	No
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?
		High