A systematic review and meta-analysis evaluated the diagnostic accuracy of teledermatology compared to face-to-face consultations for skin diseases. Out of 30,412 records, 155 studies were included, of which 139 were analyzed quantitatively. Diagnostic agreement was 76% for all skin diseases (95%-CI: 73–79%), 73% for skin cancer (95%-CI: 67–79%), and 76% for pigmented lesions (95%-CI: 67–83%). The use of dermoscopy significantly improved agreement in skin cancer from 67% (95%-CI: 58–74%) to 80% (95%-CI: 73–85%). No significant differences were found by type of communication, platform or photography device. Mean diagnostic time was 1.05 minutes per case (95%-CI: 0.98–1.12) and patient satisfaction was 82% (95%-CI: 76–87%). The study supports teledermatology as a reliable alternative for skin disease diagnosis and skin cancer screening.