Regional spread of cutaneous squamous cell carcinoma of the face via facial vein tumor thrombus: a case report.

Cutaneous squamous cell carcinoma of the head and neck most often spreads via direct extension or through lymphatics to regional lymph nodes. This is a unique case of a cutaneous squamous cell carcinoma of the nasal dorsum with direct vascular invasion of the facial vein. This was initially incorrectly identified as a regional level Ib lymph node metastases, and the intervening venous structures were neither extirpated during an initial surgery nor recognized during subsequent radiation therapy. The patient then presented with a sizable recurrence in the right suborbital subcutaneous tissue region extending into the neck and internal jugular vein. During further resection, direct tumor invasion into the facial vein was pathologically confirmed. This unusual involvement is presented as the first documented report of regional spread via tumor thrombosis within the facial vein as demonstrated in the facial vein with a tumor thrombus, as demonstrated by computed tomography and microscopic findings.