Dermatology images can be acquired using a miniature handheld digital microscope at magnifications of 10- to 30-fold. We investigated the contribution of telemicroscopy to the reliability and accuracy of teledermatology for skin tumours. In a retrospective study of the reliability of diagnosis and management plans, two dermatologists compared teledermatology with face-to-face assessment. We also measured the accuracy of diagnosis by comparing teledermatology with histopathological examination. Two dermatologists evaluated the clinical images and information for 120 randomly sorted cases and recorded a diagnosis and a management plan for each case. Two months later, the same dermatologists re-evaluated the cases and suggested a new diagnosis and management plan for each case. The reliability of teledermatology diagnosis was not significantly different from face-to-face examination; it was significantly increased with the addition of microscopic images (P < 0.001). The reliability of teledermatology management plans was not significantly different from face-to-face examination; it was significantly increased with the addition of the microscopic images (P < 0.001). The accuracy of teledermatology was significantly increased with microscopic images (P = 0.05). Telemicroscopy appears to be a useful adjunct to teledermatology with a digital camera. Future studies with different magnifications should be performed to detect the optimum magnification for telemicroscopy.