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Various modalities of treatment, including radiation\u2010, chemo\u2010, targeted\u2010, and immune\u2010 therapies may potentially induce angiotropic behavior in neoplastic cells. Although there is a risk for tumor recurrence and metastasis, angiotropism may be under\u2010recognized and is rarely reported. Here, we report a case of recurrent poorly\u2010differentiated acantholytic squamous cell carcinoma of the scalp with extensive perineural invasion, previously treated with multiple therapies. There was multifocal extravascular cuffing of neoplastic cells around and focally involving the walls of small to medium\u2010caliber blood vessels within and surrounding the tumor, without obvious tumor intravasation. In addition, small subtle nests of neoplastic keratinocytes were noted along the abluminal aspect of a large\u2010caliber deep dermal blood vessel in an en\u2010face margin, away from the main tumor mass. Such involvement can be difficult to identify; and thus, may be missed particularly during intra\u2010operative frozen section evaluation, leading to false\u2010negative margins and is therefore, a diagnostic pitfall.<\/jats:p>","DOI":"10.1111\/cup.13388","type":"journal-article","created":{"date-parts":[[2018,11,10]],"date-time":"2018-11-10T06:07:21Z","timestamp":1541830041000},"page":"152-158","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Angiotropism in recurrent cutaneous squamous cell carcinoma: Implications for regional tumor recurrence and extravascular migratory spread"],"prefix":"10.1111","volume":"46","author":[{"given":"Faysal","family":"Fedda","sequence":"first","affiliation":[{"name":"Department of Pathology The University of Texas\u2014MD Anderson Cancer Center  Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael 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