Head and neck mucosal melanoma (HNMM) is a rare, aggressive malignancy with poor survival and no standardized treatment. This study investigates the role and sequencing of surgery, radiation, immunotherapy, and chemotherapy in HNMM management. The National Cancer Database was queried for HNMM cases from 2004 to 2020. Parameters included patient demographics, disease characteristics, treatment types, and survival outcomes. Multivariable Cox proportional hazards models were used to demonstrate associations between disease characteristics and treatment type and sequence on overall survival. A total of 3704 adult cases were included. Advanced age, positive surgical margins, advanced stage, male sex, and treatment outside of an academic center were correlated with reduced survival. Surgery was utilized in most cases (79.3%) and its inclusion in any treatment combination significantly improved survival (HR = 0.52, p < 0.001). Immunotherapy following surgery showed improved survival (HR = 0.87, p = 0.017). The use of radiation or chemotherapy alone correlated with poorer survival. Multimodal treatments showed survival benefits, particularly those that included both surgery and immunotherapy. Surgery remains paramount in the treatment of HNMM. Immunotherapy shows promise in multimodal regimens, though optimal sequencing warrants further investigation. Standardized guidelines and prospective studies are needed.