SC 165 begins at the entrance to Stevens Towing Co., Inc. along the banks of the Wadmalaw River on Yonges Island.

[4] Established in 1939 as a new primary highway, SC 165 originally traversed 7.1 miles (11.4 km) from its current southern terminus to US 17 in Ravenel.

This section has remained relatively unchanged; with an exception in Hollywood, where it was realigned in the 1980s, removing a concurrency with SC 162 and leaving Town Council Road.

Entering the city from the southeast, it had a concurrency with US 17 Alternate for 1.1 miles (1.8 km), before taking a left onto Richardson Avenue.

[6][7] In 2000, SC 165 was removed from downtown Summerville, and was rerouted onto Berlin G. Myers Parkway and went northeast to its current northern terminus at US 17 Alternate.