Malignant melanoma is a malignant tumor of pigment cells of the skin and mucosa. It is one of the most aggressive tumors in humans. Although melanoma makes up to 4 % of all malignant skin diseases, almost 80 % of the deaths of skin tumors are caused by it. Melanoma incidence has been steadily increasing over the last decades, so melanoma has become a public health issue. Thanks to a well developed lymphatic network, especially in the area of the head and neck, melanoma can easily and quickly limphogenously and hematogenically metastasize. In patients with positive regional lymph nodes survival is 40 % to 50 % worse than in those without them. In the early 1990s, Donald Morton popularized the sentinel lymph node biopsy (SLNB), which is today the gold standard for prognosis and further planning of treating patients with melanoma. The lymph node guard (sentinel) is the first lymph node to drain the tumor area. SLNB is indicated in early stages of melanoma with no clinical, radiological or pathohistologically proven metastases. The standard techniques used for SLNB include: preoperative lymphoscintigraphy, lymphotropic blue dye application, and sentinel detection by hand gamma camera. In the area of the head and neck, SLNB is performed in endotracheal anesthesia. In patients with a positive sentinel, neck dissection is required to prevent further disease spread. Patients with a negative sentinel should be monitored clinically.