We have been conducting pathological diagnosis of routine cases in the Federated States of Micronesia by telepathology since 2018, using realtime screen sharing via the Internet with Japan. The number of cases covered in the last three years was 378, and by specimen type, gynecologic specimens were the most common, followed by oral cavity / ENT, skin, and mammary gland. Thirty four out of 60 oral cavity cases were diagnosed as malignant including suspicious. The turnaround time between submission of the specimen and the report of pathological diagnosis was markedly decreased. For the continuous development of global telepathology, it is necessary not only to build a system but also to recruit or train those who perform it.