Abnormal retropharyngeal lymph nodes (RLN) have prognostic relevance for patients with oral, oropharyngeal or nasopharyngeal squamous cell carcinoma (SCC). However, consensus on the evaluation and management of abnormal RLN in these patients is lacking. The authors of this paper provided a structured review on the topic and included 32 papers for full analysis. They found that RLN involvement was most commonly seen in nasopharyngeal carcinoma, followed by oropharyngeal carcinoma and SCC of the oral cavity. The involvement of RLN in nasopharyngeal cancer was associated with high rates of metastasis and lower disease-free or progression-free survival. Therefore, involvement of RLN in these patients warrants adjuvant radiotherapy and the authors recommended prophylactic irradiation of these nodes. Management of RLN in non-nasopharyngeal cancers was complicated by difficult access, inconsistencies in radiological staging criteria and a lack of robust correlations between radiological and pathological findings. RLN involvement was also found to be an independent prognosticator in human papillomavirus (HPV) positive cases of oropharyngeal SCC, although high-risk HPV strains did not correlate with metastasis to the RLN. Overall, there is a lack of randomised trials across all cancer types and a lack of consistency in the presentation of results. Advancement in techniques, such as sampling of RLN by means of transoral ultrasound-guided fine needle aspiration, could aid in identifying patients who would benefit from adjuvant treatment and the authors call for more randomised trials in the future that include these techniques.