EditorWe read with great interest the paper written by H. Liu et al. on real-time teledermoscopy in agricultural population.1 However, we cannot understand how the authors, given the results of their study, can explain in conclusion that this method and this approach could be useful for improving skin cancer screening in at-risk populations. In fact, they explain that of 289 patients seen, 199 patients were found with 390 suspicious lesions. The number of people and, above all, of lesions identified as doubtful is extremely high. They found that 69% of their patients should be referred to a dermatologist and, what's more, they found patients with more than one suspicious lesion. In our opinion, this appears to be a very poor performance. It is likely that the participation in a 1-day course on the diagnosis and dermoscopy of skin tumours was not only not helpful, but also created doubts in the minds of doctors, leading them to identify more suspicious lesions referring more patients to a second level of evaluation. Perhaps it would have been useful to include in the study a control group with doctors who had not attended a preparatory course to analyse the differences and the real efficacy of the course. Such an approach, if applied in large numbers, can cause an increase in unnecessary visits, anxiety in patients and an overcrowding in clinics, with an increase in waiting lists in dermatology clinics for the early detection of skin cancers. If this approach is being implemented to optimize and save resources, we think that it would be cheaper to use a dermatologist on-site: the patient would be saved the first visit, the dermatologist would see directly 30% of patients in more, and this would save patients' and doctors' time with only one visit.Normally, a GP, no particular courses, has clearly better and he does not send the 70% of his patients to a second skin examination. 2 The literature is still discussing the efficacy of teledermatology -and even more so of teledermoscopy -performed by dermatologists, let alone by non-dermatologists. Telediagnosis and face-to-face diagnosis reliability for melanocytic and non-melanocytic 'pink' lesions.