Numerous volcanic scoria (VS) cones are found in many places of the world. Many of them have not yet been investigated, although few have been used as binders for a very long time. The use of natural pozzolans as cement replacement could be considered as a common practice in the construction industry due to the related economic, ecologic and performance benefits. This chapter highlights the advantages and disadvantages of the use of volcanic scoria as cement replacement in concrete mixes in terms of fresh and hardened concrete properties. The chemical and mineralogical composition of volcanic scoria samples collected from 36 countries is presented in this chapter, with some further analysis. The effects of using volcanic scoria as cement replacement on some paste, mortar and concrete properties, such as the setting times, the heat of hydration, the compressive strength, the water permeability and the chloride penetrability, have been studied. The improvement in resistance against the chemical attack of volcanic scoria-based cement mortar has also been highlighted. Some estimation equations depending on the data available in literature have also been derived from the analyzed data. The modification of the microstructure of VS-based cement paste has been confirmed, as well.