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Preoperative lymphoscintigraphy is mandatory to identify the regional nodal basin(s) accurately for a newly diagnosed H&amp;N primary melanoma of at least 1\u2009mm or greater. A wide local excision should be delayed if SLN mapping is indicated, to minimize watershed effect and maximize accuracy in identifying the \u201ctrue\u201d SLN because of the complex lymphatic network in the H&amp;N region. An experienced multidisciplinary team is required for optimal identification of H&amp;N SLNs. In general, selective SLND can replace ELND to minimize the complications of a neck dissection. Completion lymph node dissection is only indicated when the SLN is positive. A nerve stimulator should be used during selective SLND in the parotid and posterior triangle to minimize the injury to the facial and spinal accessory nerve. J. Surg. 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