JMIR Publications

ABSTRACT

Skin cancer is one of the most common malignancies globally, with rural populations disproportionately affected by delays in diagnosis due to geographic isolation, healthcare workforce shortages, and systemic inequities. Teledermatology has emerged as a promising strategy to expand access to dermatologic care in underserved areas. This review synthesizes findings from studies published between 2015 and 2025 evaluating the diagnostic performance, implementation challenges, and equity implications of teledermatology in rural skin cancer care. Modalities assessed include store-and-forward systems, live video consultations, mobile teledermoscopy, and remote confocal microscopy. Diagnostic sensitivity ranged from 41.9% to 100%, and specificity from 46% to 90%, with several studies demonstrating strong concordance with in-person assessments. Use of teledermatology consistently reduced time to diagnosis, in some cases by more than 75%, and patient satisfaction was reported as high across multiple interventions. Key barriers identified included broadband limitations, inconsistent imaging protocols, digital literacy gaps, and reimbursement issues. Facilitators of success included structured workflows, dermoscopy use, centralized platforms, and integration with primary care. The review also highlights the need for targeted implementation strategies to ensure equitable access, particularly for low-income, older, and linguistically diverse populations. While teledermatology shows substantial promise in improving rural skin cancer outcomes, further research is warranted to evaluate long-term clinical effectiveness, cost-efficiency, and sustainable integration into rural healthcare systems.