Tan 2009.

Study characteristics
Patient sampling	Study design: case‐control (dermoscopy training study) Data collection: retrospective image selection/prospective interpretation Period of data collection: NR Country: UK
Patient characteristics and setting	Inclusion criteria: test series of images of melanomas and benign lesions; source of images NR Setting: not described; training images Prior testing: selected for excision (no further detail) Setting for prior testing: unspecified Exclusion criteria: none reported Sample size (participants): NR Sample size (lesions): number included: 30 Participant characteristics: none reported Lesion characteristics: none reported
Index tests	Dermoscopy: (modified) pattern analysis Method of diagnosis: clinical photographs and dermoscopic images Prior test data: participants presented with a test card printed on A4 laminated paper for each lesion, each consisting of 1 macroscopic and 1 dermatoscopic image Diagnostic threshold: excise or not (algorithm not further described) Diagnosis based on: average (n = 6; all based at same university hospital); the study authors presented 2x2 based on adding each 2x2 cell together for all observers; to avoid double counting of lesions for this review, all 2x2 cells were divided by 6 to get average result. Observer qualifications: dermatology specialist registrar 3; dermatologist 3 Experience in practice: mixed Experience with dermoscopy: low; before the study, none had routinely used a dermatoscope. Dermoscopy training: participants received an online tutorial (www.dermatoscopy.org) teaching the Modified Pattern Analysis Diagnostic Algorithm (Steiner 1987a; Carli 2003a) and was given a dual polarizing LED dermatoscope to use in clinical practice for 10 months. At the end of the study, the test‐card questionnaire was repeated. Length of training NR; online tutorial Post‐training experience: 10 months Training format: online
Target condition and reference standard(s)	Reference standard: histological diagnosis alone (not further described) Disease‐positive: 15; disease‐negative: 15 Target condition (final diagnoses) Melanoma (in situ and invasive, or NR): 15 Other: 15 (9 naevi, 1 blue naevus, 3 seborrhoeic keratoses, 1 lentigo and 1 vascular lesion)
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?	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 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?	No
		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