Background: Cutaneous melanoma is the leading cause of skin cancer-related mortality, and early detection is crucial to improving prognosis. Teledermatology (TD) has increasingly been adopted in melanoma care to address growing demand and limited access to specialists. This systematic review aimed to evaluate the role of TD in the diagnosis and management of suspected melanoma under real-world clinical conditions. Methods: The review was conducted and reported in accordance with the PRISMA 2020 guidelines. Literature searches were performed in PubMed, Embase, Web of Science, and Scopus up to December 2024. Studies assessing TD use in routine practice were included, focusing on diagnostic accuracy, prognostic indicators, waiting times, satisfaction, and economic outcomes. Results: TD showed high sensitivity and specificity, particularly when dermoscopic images and expert interpretation were available. Some studies reported reduced Breslow thickness and shorter delays compared to face-to-face care. Overall satisfaction was high among both patients and clinicians. Economic evaluations suggested potential cost savings, although formal analyses were limited. The use of artificial intelligence tools yielded mixed results and was generally perceived with caution in the absence of clinical supervision. Conclusions: Teledermatology appears to be a useful approach for improving access and supporting early diagnosis in melanoma care. Its effectiveness depends on proper implementation and integration into clinical workflows.