AbstractDermatology departments actively use digital solutions to provide services remotely, particularly to supplement overbooked face-to-face clinics. In coastal areas, there are additional challenges regarding provision of access to dermatology, with few centres offering dermatology appointments, and with patients not always having the means to travel. This paper discusses how the teledermatology service in one of the coastal ‘deserts of provision’ both widens access to secondary care and unmasks unmet need in these communities. The methods used involve direct comparison of the number of dermatology referrals from primary care, both before the establishment of the teledermatology service and afterwards. The teledermatology service examined has been established in coastal locations, offering photography and dermoscopic images of lesions, submitted with a standardized patient history form. The main focus of the service is to identify skin cancers and provide reassurance of benign lesions, without recourse to 2-week-wait appointments, although other skin conditions suitable for general clinics are also referred. Interestingly, the results show that the teledermatology service has had no impact on mitigating traditional referrals to routine or 2-week-wait clinics, which have continued to increase, on average by 18% in the 2-year period ending January 2024, across 24 surgeries in the region. For one surgery located in one of the most isolated areas, weekly referrals have increased by 142%, representing an increase from three to seven referrals per week. This centre also made an additional eight referrals to teledermatology per week, mainly for single lesions that general practitioners felt did not merit the 2 week wait, but that required timely dermatological opinion. Of 97 referrals examined across a 12-week period (November 2023 to January 2024), five lesions were listed directly for surgical excision, eight for biopsy and eight for further clinical evaluation. It seems evident that in providing this additional path of access, the teledermatology service has unmasked an unmet need in the coastal community. It offers a ‘dermatology department without walls’, where expert secondary care advice with consultant insight can be obtained locally, and surgical follow-up or further clinical management can be organized directly by the advising dermatology team. Further study is needed to confirm that this increased access also leads to improved patient outcomes, which is predicated on appropriate referrals to teledermatology by primary care, and assessment of the diagnostic accuracy of teledermatology compared with traditional in-person clinics. The hope is that effective dermatology specialty care is being brought to the patient more directly in coastal communities than has previously been possible.