DERMATOPATHOLOGY Obstacles hindering the mainstream practice of teledermatopathology Danielle Giambrone, BS, Babar K. Rao, MD, Amin Esfahani, MS, and Shaan Rao New Brunswick, New Jersey Background: Teledermatopathology has the potential to link underserved areas to experts across the country and assist in making quick diagnoses, which may improve health care costs and delivery. Despite these potential benefits, teledermatopathology is not used routinely for primary diagnosis in the United States. Objective: To assess the current status of and address the potential for improving health care by the use of teledermatolopathology for primary diagnosis. Methods: Current available literature and online resources were reviewed to address 3 major variables that hinder the widespread use of teledermatopathology: diagnostic accuracy, licensure requirements, and reimbursement. Results: Recent studies show similar diagnostic accuracy for this technology compared to conventional microscopy. State-to-state variation and ambiguity in laws serve as the biggest hurdles to the widespread use of teledermatopathology. More states are recognizing the importance of the implementation of specific laws regarding telemedicine. More studies are required to evaluate the systems that offer specific telemedicine licenses, in addition to those that pay for telemedicine services specifically. Limitations: This study reviewed current legislation concerning teledermatopathology; these laws are subject to revision. Conclusion: Improving diagnostic accuracy and limiting variations in policy and reimbursement may encourage more pathologists to use teledermatopathology technology. ( J Am Acad Dermatol http:// dx.doi.org/10.1016/j.jaad.2014.04.043.) Key words: dermatopathology; digital pathology; teledermatology; teledermatopathology; telehealth; telepathology; virtual microscopy. T elemedicine is defined as the use of medical information exchanged from 1 site to another via electronic communications to improve patient’s health. 1 It is generally divided into 2 categories: store and forward and live real-time. Store and forward uses still digital images of patient data for rendering a medical opinion or diagnosis and includes the asynchronous transmission of data from 1 site to another. Live real-time or synchronous transmission is an interactive video connection that transmits information in both directions during the same time period. 1 Telepathology is a subset of telemedicine that focuses on pathologic diagnosis by examination of digital histologic slides from a remote location. Telepathology, more specifically teledermatopathol- ogy, has the potential to transform the practice of dermatopathology by linking rural and underserved communities—where caseloads exceed the number of experts—to specialists across the country. In From the Department of Dermatology, Rutgers Robert Wood Johnson Medical School, New Brunswick. Funding sources: None. Conflicts of interest: None declared. Accepted for publication April 16, 2014. Reprint requests: Babar K. Rao, MD, Department of Dermatology, Rutgers Robert Wood Johnson Medical School, 1 World’s Fair Dr, Ste 2400, Somerset, NJ 08873-1344. E-mail: babarrao@gmail. com. Published online June 4, 2014. 0190-9622/$36.00 Ó 2014 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2014.04.043 1