Abstract Subacute cutaneous lupus erythematosus (SCLE) is a rare photosensitive dermatosis that has been classically categorized as idiopathic or drug-induced. A proliferation of case reports and small case series support the hypothesis that the presentation of new-onset idiopathic SCLE can be a facultative paraneoplastic phenomenon. There remains a lack of consensus regarding the investigations that this dermatosis should initiate, and in which patients. The aims were to investigate the proportion of patients with biopsy-consistent SCLE who had an underlying malignancy, and to analyse the demographic, clinical and laboratory characteristics associated with this. We conducted a histopathology database word search of skin biopsy reports from 1995 to 2021. We performed a retrospective chart review of electronic and paper records and analysed demographic, clinical and laboratory data of patients with possible SCLE. This study received full ethical approval from the relevant local research ethics committee. Of 64 patients initially identified, 35 had SCLE following clinicopathological correlation and had sufficient data available for inclusion. In this cohort, a total of 16 (46%) patients had a malignancy, either preceding or following SCLE diagnosis. In eight (23%) patients, malignancy was diagnosed within 1 year of SCLE onset. SCLE was considered drug induced in 14 (40%) of cases. Eleven (31%) cases were considered to be idiopathic; of these, five (45%) were subsequently diagnosed with malignancy. Malignancies subsequent to the diagnosis of idiopathic SCLE all occurred in women (aged 66–74 years). There were no significant differences in the autoantibody profiles between patients with malignancy and the overall SCLE cohort. Malignancies were detected, on average, 41 days (range 11–74) after the diagnosis of SCLE. Subtypes of cancer diagnosed post-SCLE were lung (n = 4, all current or ex-smokers) and colorectal (n = 1, a never smoker). In four of these cases, investigation for malignancy was specifically advised by dermatology. This is the first reported retrospective study to explore the under-recognized association between SCLE and malignancy. Clinicians should be aware of the potential paraneoplastic nature of SCLE, especially in the context of risk factors such as smoking history and an older age profile.