Skin carcinomas of the head and neck can produce lymphatic metastases: the main lymphatic station of drainage is in the lymph nodes of the parotid region, especially for tumours of the upper 2/3 of the face. The analysis of the prognostic factors (site of origin, etiology, immunodepression, previous treatment, size, thickness, grading, perineural invasion, rapid growth) identifies a group of patient at risk, for local recurrence and for lymphatic metastases. In those cases, representing less than 10% of these tumours, the prophylactic treatment of lymph nodes-parotid and neck nodes-can be reasonable. The cases N positive have a severe prognosis, in these patients an aggressive surgical treatment, extended to both parotid and neck nodes, followed by radiotherapy, is justified. Only prospective studies and statistical evaluation of results, could define the real prognostic importance of different factors and the best treatment for the lymph nodes.