Cutaneous squamous cell carcinoma (cSCC) is the second most frequent cancer of the skin and most often arises in sun-exposed anatomic sites of individuals with fair skin, like the head and neck; ear and lip tumours can be particularly aggressive. The most important risk factors are cumulative sun exposure and organ transplantation-induced immunosuppression. Invasive cSCC can be flat, nodular or a plaque with flesh-like or red colour, hyperkeratosis and ulceration with oozing/bleeding/crusting. Clinical diagnosis can be supported through dermoscopy (white circles) and confirmed through incisional biopsy. Classification of cSCCs into low risk, high risk and very high risk based on clinical and histopathological criteria helps guide treatment and follow-up. First-line gold standard treatment for primary resectable cutaneous SCC is surgical excision. If there is clinical suspicion of lymph node involvement, ultrasonography-guided aspiration should be offered. In case of confirmed metastasis, therapeutic regional lymphadenectomy should be performed after TNM staging via imaging. Levels of neck dissection depend on the location of the primary tumour. In case of nodal metastasis of the parotid gland, therapeutic parotidectomy (usually superficial) along with neck dissection should be performed. Radiotherapy can be used as primary or adjuvant treatment. Immune checkpoint inhibitors are first-line treatment for patients with locally advanced or metastatic cSCC, excluding patients with organ transplantation.