Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with incidence rates projected to rise due to increased exposure to risk factors. Surgical excision is the mainstay treatment for low-risk cSCC, but high-risk cases require complex management. This review highlights the pathogenesis, molecular markers, and histologic subtypes of cSCC, emphasizing diagnosis and management. cSCC is associated with high mortality, particularly in certain populations. Risk factors include UV exposure, immunosuppression, and genetic conditions. Molecular studies show that cSCC has a high mutational burden, with mutations in genes like TP53, CDKN2A, and NOTCH1/2 playing key roles. The tumor microenvironment is also critical, with factors like TGF-β and regulatory T cells influencing progression. High-risk cSCC is characterized by features such as tumor size, perineural invasion, and poor differentiation. Treatment options include surgery, immunotherapy (e.g., PD-1 inhibitors), EGFR inhibitors, and radiation. Chemoprophylaxis is recommended for high-risk populations, including immunosuppressed individuals. Preventative measures involve sun protection and regular dermatologic exams. Future research focuses on improving treatment strategies, including vaccines against HPV and targeting PI3K/mTOR pathways. The review underscores the need for personalized approaches and multidisciplinary management in cSCC care.Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with incidence rates projected to rise due to increased exposure to risk factors. Surgical excision is the mainstay treatment for low-risk cSCC, but high-risk cases require complex management. This review highlights the pathogenesis, molecular markers, and histologic subtypes of cSCC, emphasizing diagnosis and management. cSCC is associated with high mortality, particularly in certain populations. Risk factors include UV exposure, immunosuppression, and genetic conditions. Molecular studies show that cSCC has a high mutational burden, with mutations in genes like TP53, CDKN2A, and NOTCH1/2 playing key roles. The tumor microenvironment is also critical, with factors like TGF-β and regulatory T cells influencing progression. High-risk cSCC is characterized by features such as tumor size, perineural invasion, and poor differentiation. Treatment options include surgery, immunotherapy (e.g., PD-1 inhibitors), EGFR inhibitors, and radiation. Chemoprophylaxis is recommended for high-risk populations, including immunosuppressed individuals. Preventative measures involve sun protection and regular dermatologic exams. Future research focuses on improving treatment strategies, including vaccines against HPV and targeting PI3K/mTOR pathways. The review underscores the need for personalized approaches and multidisciplinary management in cSCC care.