Abstract
Background/Objectives: Early melanoma management depends on rapid triage and definitive treatment. Image-enabled teledermatology, particularly teledermoscopy, may accelerate pathways without compromising safety. This review evaluated effects on timeliness, diagnostic performance, and initial prognostic severity at diagnosis. Methods: Following a preregistered PRISMA-2020 protocol, PubMed/MEDLINE, Embase, and Scopus were searched from inception to 1 September 2025. Comparative clinical studies and service evaluations reporting melanoma-specific outcomes were eligible. Dual screening, duplicate data extraction, and risk-of-bias appraisal were performed; substantial clinical and methodological heterogeneity precluded quantitative meta-analysis, so findings were synthesized narratively. Results: Twelve studies met criteria. Front-end intervals consistently shortened: time to expert advice was ≈1 day and median time to first clinic was reduced by ~10 days versus conventional referral. Downstream milestones showed mixed translation, with time to excision and histology in several programs remaining ≈45-67 days, indicating capacity constraints beyond triage. Diagnostic safety was high where quantified: melanoma triage sensitivity approached ~99% with a false-negative rate near ~1.1%, and positive predictive value for suspected-melanoma referrals was ~45-50% in mature services. Selected observational comparisons suggested a ≈0.6 mm lower mean Breslow thickness and ~13-percentage-point higher in situ/T1 proportion in one TD network, although these findings are susceptible to selection and lead-time bias and are not consistent across all settings. Overall, teledermoscopy functioned as a "front-door accelerator," with pathway gains being largest before surgical and pathology steps. Conclusions: Teledermatology/teledermoscopy reliably compresses referral-to-decision intervals and maintains high triage safety, with indications of stage migration toward thinner tumors at diagnosis. Integrating surgical and pathology capacity is essential to convert early advice into earlier definitive treatment.