Posterolateral neck dissection has become the standard operative technique in the surgical management of metastatic adenopathy among patients with cutaneous malignancies of the posterior neck and scalp. This technique has been used in both the staging and therapeutic settings but is reserved today primarily for oncological resection of clinical disease. This dissection includes removal of lymph node levels II through V along with the suboccipital, retroauricular, and nuchal nodes, which are common sites of spread for cutaneous malignancies of the posterior scalp, suboccipital region, retroauricular region, and posterosuperior neck. The most common indication is for metastatic cutaneous malignant melanoma and squamous cell carcinoma, although soft-tissue sarcomas can present in this region and necessitate regional dissection. The aim of this review is to delineate the preoperative evaluation and intraoperative considerations of the posterolateral neck dissection.