The study compared the diagnosis of basal cell carcinoma (BCC) via teledermatology in 2022 and face-to-face consultations in 2019 in a southern European hospital, analyzing 486 histologically confirmed tumors (201 face-to-face, 285 teledermatology). Mean tumor depth was significantly lower in the teledermatology group (1.67 mm vs. 2.51 mm; p < 0.001). The distribution of histological subtypes differed (χ² = 41.3; p = 0.002): superficial BCCs were more frequent in face-to-face consultations (15.9% vs. 8.8%), nodular and micronodular were more prevalent in teledermatology (65.6% vs. 3% vs. 16%), sclerodermiform were slightly more frequent in person (17.9% vs. 12.3%). When grouped into non-aggressive (superficial/nodular) and aggressive (micronodular/sclerodermiform) subtypes, the distribution differed, with no predominance of low-risk teledermatology. In multivariable logistic regression, tumor depth was the only independent predictor of diagnostic pathway (β = -1.10; p < 0.001). Teledermatology has enabled the diagnosis of shallower BCCs across subtypes, promoting earlier detection.