Stolz 1994a.

Study characteristics
Patient sampling	Study design: case series Data collection: retrospective image selection/prospective interpretation Period of data collection: from 1989‐1991 Country: Germany Test set derived: 157 cases were randomly divided into a test and training set.
Patient characteristics and setting	Inclusion criteria: equivocal melanocytic skin lesions < 9 x13 mm, melanoma tumour thickness of ≤ 1 mm and melanoma Clark's ≤ level III Setting: secondary (general dermatology); Univerisity of Munich Department of Dermatology Prior testing: selected for excision (no further detail) Setting for prior testing: NR Exclusion criteria: none reported Sample size (participants): NR Sample size (lesions): number eligible: 650 cases/number included: 157 lesions Participant characteristics: none reported Lesion characteristics: melanoma thickness: 50 ≤ 0.4 mm; 30 ≤ 0.75 mm; 15 ≤ 1 mm
Index tests	Dermoscopy: ABCD Method of diagnosis: dermoscopic images; colour prints examined for 31 dermoscopic features, most listed in the guidelines of the Consensus Conference of Surface Microscopy held in Hamburg in 1989 (Bahmer 1990); described as a "blind study" Prior test data: no further information used Diagnostic threshold: > 5.45; multivariate analysis of training set data identified 8 features with the lowest P values; the total dermoscopic score (TDS) was then developed based on: asymmetry score x 1.3 + Border score x 0.1 + Colour score x 0.5 + Differential structure score x 0.5. New formula then evaluated on the test set of images. Diagnosis based on: single observer (n = 1) Observer qualifications: NR; co‐author, assumed to be dermatologist Experience in practice: not described Experience with dermoscopy: not described
Target condition and reference standard(s)	Reference standard: histological diagnosis alone Details: histology undertaken by 2 independent histopathologists Disease‐positive: test set = 48; disease‐negative: test set = 31 Target condition (final diagnoses) Melanoma (invasive): 85; melanoma (in situ): 10 'Benign' diagnoses: 62 melanocytic naevi; 17 junctional; 40 compound; 5 dermal
Flow and timing	Participant exclusions: none reported Index test to reference standard interval: not described
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?	Yes
Was a case‐control design avoided?	Yes
Did the study avoid inappropriate exclusions?	No
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 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	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