Dermatopathologic features of cutaneous squamous cell carcinoma and actinic keratosis: Consensus criteria and proposed reporting guidelines

Rachel E. Christensen, Dirk M. Elston, Brandon Worley, McKenzie A. Dirr, Noor Anvery, Bianca Y. Kang, Soon Bahrami, Robert T. Brodell, Lorenzo Cerroni, Carly Elston, Tammie Ferringer, M. Yadira Hurley, Kyle Garton, Joyce Siong See Lee, Yeqiang Liu, John C. Maize, Jennifer M. McNiff, Ronald P. Rapini, Omar P. Sangueza, Christopher R. SheaCheng Zhou, Murad Alam*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: There is considerable variation in the literature regarding the dermatopathologic diagnostic features of and reporting guidelines for actinic keratosis (AK) and cutaneous squamous cell carcinoma (cSCC). Objective: To develop consensus recommendations regarding diagnostic criteria, nomenclature, and reporting of AK and cSCC. Methods: Literature review and cross-sectional multiround Delphi process including an international group of expert dermatopathologists followed by a consensus meeting. Results: Consensus was achieved regarding the key dermatopathologic features necessary for diagnosing cSCC, AK, and associated variants; grading of degree of cellular differentiation in cSCC; utility of immunohistochemistry for diagnosis of cSCC; and pathologic features that should be reported for cSCC and AK. Limitations: Consensus was not achieved on all questions considered. Conclusion: Despite the lack of clarity in the literature, there is consensus among expert dermatopathologists regarding diagnostic criteria and appropriate reporting of AK and cSCC. Widespread implementation of these consensus recommendations may improve communication between dermatopathologists and clinicians, facilitating appropriate treatment of AK and cSCC.

Original languageEnglish (US)
Pages (from-to)1317-1325
Number of pages9
JournalJournal of the American Academy of Dermatology
Issue number6
StatePublished - Jun 2023


  • actinic keratosis
  • consensus
  • diagnosis
  • immunohistochemistry
  • international
  • pathology
  • squamous cell carcinoma

ASJC Scopus subject areas

  • Dermatology


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