Objectives: Studies addressing social determinants of health (SDH) in head–neck melanomas (HNM) have only assessed incidence with increasing socioeconomic status. None have investigated a wider scope of SDH or their summed influence on affecting HNM prognosis and follow‐up care. Methods: This retrospective cohort study analyzed 374,138 HNM in adults from 1975 to 2017 from the NCI‐Surveillance, Epidemiology, and End Results Program (NCI‐SEER) database. Utilizing the NCI‐SEER database, Social Vulnerability Index (SVI) scores were matched to county of residence upon diagnosis. Univariate linear regressions were performed on length of care (months of follow‐up/surveyed) and prognosis (months survival) across various SDH/SVI scores of socioeconomic status, minority and language status, household composition, housing and transportation, and their total composite. Results: With increasing overall SVI score, which indicates increasing social vulnerability, months of follow‐up showed significant decreases ranging from 0.04% to 27.63% compared with the lowest vulnerability groups, with the highest differences in nodular melanomas and the lowest with malignant melanomas in giant pigmented nevi. Similarly, months survival significant decreases ranged from 0.19% to 39.84% compared with the lowest SVI scores, with the highest difference in epithelioid cell melanomas and the lowest in amelanotic melanoma. Comprising this overall score trend, decreases with socioeconomic status, minority‐language status, household composition, and housing‐transportation contributed differentially per histology subtype. Conclusions: Our data highlight significant negative trends in HNM prognosis and care with higher total social vulnerability while showing which SDH‐themes quantifiably contribute more to these differences. Level of Evidence: 3 Laryngoscope, 134:185–190, 2024 [ABSTRACT FROM AUTHOR]