A case of epidermoid carcinoma with metastasis to a cervical lymph node is reported. Due to an intense granulomatous reaction and the similarity of the neoplastic cells with the epithelioid cells there was diagnostic difficulty when based only on histology and fine needle aspiration cytology. The utilization of electron microscopy and immunoperoxidase defined the diagnosis. Discussion is made about the importance of the utilization of multiples methods in surgical pathology and the pathogenesis of the granulomatous reaction associated with malignant neoplasms.