Because there are no specific reports, this retrospective study was carried out to assess the clinical outcome of stage I (i.e., T1 N0 M0) head and neck skin squamous cell carcinoma (HNSSCC) and verify the impact of some clinical parameters on prognosis. Seventy-one patients with stages I (i.e., 68 T1 N0 M0) and II (i.e., 3 T2 N0 M0) histologically proven HNSSCC were analyzed, and no lip carcinoma was considered. None was treated before admission, and none had neck nodes (i.e., N0) and/or distant metastasis (i.e., M0). Global disease-specific survival rate at 32 months was 97.2%, irrespective of stage, grading, and type of surgery, and thus, radical tumor resection is a viable procedure for stage I HNSSCC. However, 14 (19.7%) of 71 cases had a relapse within a mean period of 31 months. A second procedure was performed in 12 (85.7%) of 14 cases. In 4 (33.3%) of 12 patients operated on twice, a second relapse was detected after a mean period of 26 months.A second surgical procedure on a relapsed tumor is possible, but a multimodality treatment regimen should be considered.