Background/Objectives: Artificial intelligence (AI) holds significant potential to enhance diagnostic support and access to dermatological care; however, its adoption depends on public trust and acceptance. This study aimed to assess knowledge, attitudes, and acceptance of dermatological AI among Saudi adults, and to identify factors associated with adoption, trust, and preferred system characteristics. Methods: A nationwide cross-sectional online survey was conducted among 668 Saudi adults (≥18 years) between 21 May and 5 June 2025, using convenience and snowball sampling via social media platforms (WhatsApp, Snapchat, Twitter/X, and Telegram). The questionnaire captured demographics, attitudes toward AI (20-item Likert scale), and perceived importance of six AI system features. Data were analyzed using descriptive statistics, one-way ANOVA, and binary logistic regression. The study was approved by the Institutional Review Board of King Faisal University (Approval No. KFU-REC-2025-MAY-ETHICS3443, approval date 19 May 2025). Results: The mean overall AI attitude orientation score was 74.48 ± 10.20 (Cronbach’s α = 0.868), reflecting moderately positive but conditional attitudes toward dermatological AI. Participants strongly preferred physician-supervised AI over fully autonomous systems, with medical oversight receiving the highest agreement (mean 4.27 ± 0.87). Privacy protection and diagnostic accuracy were rated as the most important system features. Age was significantly associated with the overall AI attitude orientation score (p = 0.009), with younger participants demonstrating more favorable orientations. Interest in technology showed the strongest association with both AI attitude orientation and perceived importance (p < 0.001). No demographic variable independently predicted high intention to use AI in multivariate analysis. Conclusions: Saudi adults generally exhibit favorable yet cautious attitudes toward dermatological AI. Implementation strategies should prioritize physician oversight, transparency, data privacy, and culturally responsive design to support responsible integration into clinical practice.