Background <p>Lymph node dissection is a standardized procedure in gastric cancer surgery. Typically, lymph node metastasis begins in the perigastric (PG) region and then extends to the extraperigastric (EP) region. However, in some circumstances, skip lymph node metastasis occurs in the EP region without involvement of the PG lymph nodes. This study aims to investigate the clinical significance of skip lymph node metastasis in gastric cancer.</p> Methods <p>A total of 1,055 patients who underwent curative gastrectomy for primary gastric cancer with pathological lymph node metastasis were analyzed. Patients were categorized into three groups: the PG-only group, the PG + EP group, and the skip group. The clinicopathologic characteristics and prognosis were analyzed.</p> Results <p>The incidence of skip lymph node metastasis was 3.9% (41 of 1,055 patients). The skip group had a higher proportion of females compared to both the PG-only group (43.9% vs. 27.5%, <i>p</i> = 0.025) and the PG + EP group (43.9% vs. 26.5%, <i>p</i> = 0.017). Additionally, the skip group showed a higher proportion of intestinal-type tumors compared to the PG-only group (68.3% vs. 50.6%, <i>p</i> = 0.029) and the PG + EP group (68.3% vs. 40.2%, <i>p</i> = 0.001). Disease-free survival and overall survival in the skip group were similar to those in the PG-only group but significantly better than those in the PG + EP group.</p> Conclusions <p>Skip lymph node metastasis is uncommon, and it is associated with a higher proportion of females and intestinal-type tumors. The prognosis of the skip group was comparable to the PG-only group and significantly better than that of the PG + EP group.</p>