Cutaneous squamous cell carcinoma (cSCC) accounts for 20% of all skin malignancies and 20% of deaths. In contrast to mucosal SCC, treatment results are very good. However, regional metastases are present in 5-20% of cases, and the prognosis for patients with metastases is 50% lower. It has been reported that several risk factors are responsible for the head and neck lymph node regional metastasis, such as: poor cell differentiation, local recurrence, immunosuppression, and tumour dimension. Multivariate analysis of metastatic neck lesions in head and neck cSCC. Retrospective analysis of patients treated at our department for head and neck cSCC. The study includes 100 patients: 66 males (66%) and 34 females (34%), aged 26-98 years (mean age 74.6). The tumour was evaluated for: sex predilection, local recurrence, stage (according to 7th edition of American Joint Committee on Cancer TNM staging), differentiation, and site. Most patients (79 cases; 79%) were treated for primary cSCC, while the other 21 patients presented local recurrence of cSCC. Neck metastases were diagnosed in five patients with primary cSCC and in three with recurrent cSCC. No distant metastasis was observed. The most common tumour location was the auricle (29 cases; 29%). Neck dissection was performed most frequently in patients with lip tumours (17/22 cases; 77%). Neck metastasis was diagnosed most often in patients with cSCC on the lip (2 patients) and buccal region (2 patients). The most common tumour location in males was the auricle (25/66 cases; 38%) whereas in females the nasal and buccal regions were the most common locations, with 8 patients each (8/34 cases; 23%). Neck dissection was performed in 20 of the 66 males (30%) and in 12 of the 34 females (35%). Neck metastasis was confirmed in 5 females (15%) and 3 males (5%). The most common histopathological tumour stage was G2 (57 cases; 57%). Of the eight patients with confirmed neck metastasis, four had poorly-differentiated (histopathological stage G3). Thus, 4 of the 24 patients (17%) with stage G3 tumours experienced metastasis. Our findings suggest that factors such as local recurrence, degree of cell differentiation, tumour dimension and/or location, can increase the risk of neck metastases. For this reason, in patients with such risk factors, neck dissection should be considered to evaluate for metastatic lesions.