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Introduction: Teledermoscopy (TD), introduced in Västerbotten, northern Sweden in 2014, enables dermatological consultation in primary care via high-resolution images. As skin cancer incidence increases in Sweden, TD offers potential for diagnostic efficiency and resource optimisation. Despite increasing referrals, TD remains unevaluated. This study examines TD's impact on equitable access to dermatological assessment for skin tumours in this region.

Methods: This descriptive study analysed 67,137 TD referrals submitted between 2014 and 2024, excluding 2,384 due to incomplete data. Variables included age, diagnosis (benign vs malignant), and referral origin (public/private; urban/rural). A survey examined TD routines across primary care centres (PCCs), staff roles, training, and frequency of internal TD discussions.

Results: Over the 11-year period, mean age increased from 50 (2014) to 61 years (2024) (P < 0.001). The proportion of benign referrals decreased from 80% to 69% (P < 0.001). Private PCCs referred 78% benign lesions versus 75% from public PCCs (P < 0.001); urban PCCs referred 77% versus 73% PCCs in remote areas (P < 0.001). Assessment by a nurse was associated with higher benign referral rates (odds ratio (OR) 1.132, 95% confidence interval (CI) 1.052–1.219), whereas internal TD discussions (OR 0.714, 95% CI 0.669–0.763) and lack of dermoscopy training (OR 0.893, 95% CI 0.882–0.971) were associated with lower benign referral rates.

Discussion: TD has enhanced access to dermatological evaluation for suspected skin tumours in Västerbotten. The increasing age of referred patients and higher proportion of tumour diagnoses imply improved targeting of high-risk groups. Local routines influenced referral quality, underscoring the need for structured TD implementation.