Superficial skin biopsies are common in dermatopathology specimens and can pose a diagnostic challenge especially in cosmetic sensitive areas such as the face. When broadly transected so that the base of the lesion is not visualized, well-differentiated squamous cell carcinomas (SCC), hypertrophic actinic keratoses (HAK), irritated seborrheic keratoses (ISK), and verruca vulgaris (VV) can look quite similar on light microscopic examination. When we encounter such a biopsy in which atypia is not visualized in the upper half and thus a benign lesion is favored but a premalignant or malignant squamous neoplasms cannot be excluded, we sign out these cases as squamous acanthomas (SA) transected cannot rule out malignancy with a note recommending clinical follow up and /or repeat deeper biopsy

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