Melanomas of the posterior scalp, posterior superior aspect of the neck and postauricular region metastasize primarily to the retroauricular and suboccipital lymph nodes, which are not included in the standard neck dissections. These nodes drain into the spinal accessory nodes and also into the upper jugular nodes. Therefore, a therapeutic lymphadenectomy for melanomas in these locations requires a distinct operation that has been named “posterolateral neck dissection”. It consists of the removal of the suboccipital and retroauricular nodes in addition to the nodes in level II–V. The main variations in surgical technique described in the chapter concern the handling of the splenius capitis muscle. Some surgeons describe lymph nodes deep to the upper portion of this muscle, along the deep portion of the occipital artery and advocate resecting it to ensure their removal. Most surgeons, however, do not include the splenius in the resection and carry the dissection in a plane immediately superficial to this muscle. Otherwise, depending on the location and extent of the nodal metastases in the neck, it is often possible to preserve the spinal accessory nerve, the internal jugular vein (IJV) and sometimes the sternocleidomastoid muscle (SCMM).