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The aim of present study was to better define the role of sentinel lymph node biopsy (SLNB) in high‐risk cutaneous squamous cell carcinoma of the head and neck (cSCCHN). A systematic review and meta‐analysis was performed according to the PRISMA statement. Seven‐hundred and five patients were included from 20 studies. The pooled SLN identification rate was 98.8% (95%CI: 97.0–99.8). The median number of SLN excised was 3.6 (n = 371, 95%CI: 2.0–4.4). The pooled SLNB positive rate and cumulative regional recurrence rate (RRR) in negative SLNB were 5.6% (95%CI: 2.6–9.6) and 2.9% (95%CI: 0.5–7.2), respectively. Further studies are mandatory to define predictors of lymph node metastases able to better select patients that may benefit from a SLNB.
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