We recently reported on the safety of minimally invasive parotid region sentinel node biopsy and level I-sparing radical neck dissection for head and neck melanoma. We therefore wished to assess the state of practice in the United States through a survey of specialists in head and neck surgery. We hypothesized that there would be significant variation in the management of these facets of head and neck melanoma. To test this hypothesis, a 10-question online survey on management of head and neck melanoma was distributed to the members of the American Head and Neck Society. Responses were matched to Internet Protocol addresses to ensure that each respondent completed the survey only once. Eighty-eight respondents completed the survey. For sentinel lymph nodes within the parotid gland, nearly half (47.7%) of surgeons surveyed perform a superficial parotidectomy, 13.6% perform a total parotidectomy, and only 38.6% perform parotid-sparing surgery; 71.6% of surgeons remove the submandibular nodes when carrying out a functional radical neck dissection. In conclusion, approaches to the management of head and neck melanoma vary widely, with only a minority of surgeons using morbidity-sparing surgical approaches. This study highlights the need for further randomized controlled trials in the surgical management of head and neck melanoma.