Purpose Sentinel lymph node (SLN) biopsy is a staging procedure in the management of cutaneous malignancies of the head. The ideal radiopharmaceutical is controversial. This study aimed to compare 99m TcTc-tilmanocept (TcTM) with 99m TcTc-sulphur colloid (TcSC) and 99m TcTc-albumin colloid (TcAC) for SLN detection in the head and neck region. Methods Data from 62 patients with cutaneous malignancies of the head who were injected with TcTM, TcSC, or TcAC before SLN imaging (SLN-I) and SLN excision (SLN-E) between 2012 and 2021 were retrospectively analysed. SLN-I was performed using planar lymphoscintigraphy and SPECT/CT, and a gamma probe was used for SLN-E. The SLN-I localisation rate (patients with SLNs) and degree (SLN number) and SLN-E relocalisation rate (patients with SLNs) and ratio (SLN number in SLN-E/SLN number in SLN-I) were compared between TcTM, TcSC, and TcAC. Results TcTM showed similar SLN-I localisation rates for primaries in the anterior and posterior head region compared with TcSC (84.6% vs. 72.4%, p =0.680; both 100.0%) and TcAC (84.6% vs. 75.0%, p =1.000; both 100.0%). The SLN-I localisation degree for TcTM was higher for primaries in the anterior head region and similar for primaries in the posterior head region compared with TcSC (3.2 vs. 2.3, p =0.034; and 1.8 vs. 2.2, p =0.506) and TcAC (3.2 vs. 2.0, p =0.038; and 1.8 vs. 2.7, p =0.329). The SLN-E relocalisation rates and ratios were similar for all. Conclusion On the basis of a limited study design that compared three different tracers in three different patient groups, TcTM showed comparable overall performance to TcSC and TcAC.