Abstract
Background: Most teledermatology studies include reviews of programs on a limited scale, whereas there are fewer reports on how to expand a program to accommodate high patient volumes.
 Objective: To share our insights into the growth and maintenance of a teledermatology program that sees over 100,000 cases a year. 
 Methods: Retrospective review of a teledermatology program between 2015 and 2022. Outcomes were compared between the initial phase from 2015-2017 and the maturation phase from 2018-2022.
 Results: In 2015, the teledermatology program was piloted in 3 hospital centers and expanded to 10 more centers by 2017. There was a total of 12,385 cases in 2015, which increased to 139,110 cases in 2022. Despite the dramatic increase in number of cases, our program adapted well: the initial phase of program development resulted in 69.2% of concerns being treated remotely, compared to 70.9% of submissions in the later years, p <0.001.
 Limitations: Overall generalizability as this study was performed in a large integrated health system.
 Discussion: We maintain that the following can help scale a teledermatology program: 1. Communication with all interested parties; 2. Streamlined implementation of technological devices; 3. Training for dermatologists and primary providers; 4. Image guidelines to maintain photo quality.
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