Background Australia introduced structured pathology reporting guidelines for non-melanoma skin cancer (NMSC) including cutaneous squamous cell carcinoma (cSCC) in 2023 to encourage accurate histological assessment and recording of well recognised adverse prognostic factors that inform prognosis and the need for additional treatment. Deaths from cutaneous squamous cell carcinoma (cSCC) are increasing. Identifying high-risk cSCC (HRcSCC) cases early is critical, and the pathologist has a central role to play.

Objectives To establish the completeness of cSCC pathology reports under existing practice before 2023.

Materials and Methods Pathology reports for a consecutive series of cSCC referred to a University Hospital multidisciplinary team (MDT) during 2022 were audited against the new guidelines.

Results Of 156 cSCC cases referred to MDT, 87 met inclusion criteria. All macroscopic criteria were consistently reported (95%–100%). Most microscopic criteria (margin status, histological subtype, histological grade, perineural invasion [PNI] and anatomic extent of invasion) were consistently included (94%–100%); however, lymphovascular invasion (LVI) (80%), depth of invasion (DOI) (33%) and satellitosis/in transit metastasis (SITM) (0%) were notable omissions.

Discussion Critical prognostic factors were frequently omitted from narrative reports. While most narrative-style reports for cSCC contain most of the main prognostic criteria, the use of structured reports may improve the completeness of cSCC pathology reporting.