Purpose Sentinel node biopsy (SNB) for primary melanoma has a well-established role in reducing the risk of regional node recurrence. However, the only randomised controlled trial (RCT) of SNB (MSLT-I) was underpowered to determine if it also reduced the risk of death from melanoma. This systematic review and meta-analysis aimed to resolve this ongoing controversy. Methodology Medline, Embase, Cochrane CENTRAL and ClinicalTrials.gov were searched (to 8/1/2025) using terms for melanoma, SNB and survival. Only studies reporting melanoma survival in patients who underwent SNB relative to patients who did not were included. Duplicate title review and data extraction were performed. The RCT and studies reporting adjusted risks were meta-analysed for the risks of death from melanoma and recurrence. Newcastle-Ottawa and Cochrane Collaboration tools were used for risk of bias assessment. Results 60 studies were included in the systematic review, from 1,560 titles and 13 studies (40,287_patients) were suitable for meta-analysis. This showed a significantly-reduced risk of death from melanoma for patients who underwent SNB; hazard ratio (HR) 0.86 (95%CI 0.81-0.92, p<0.00001), with low heterogeneity (I2 16%). This result was not dependent on any single study or use of systemic therapy, as confirmed by sensitivity analyses. Nine studies (11,625 patients) reported an adjusted risk of recurrence, from which the overall HR was 0.71 (95%CI 0.66-0.76, p<0.00001) with low heterogeneity (I2 23%). Conclusion This meta-analysis demonstrated that undergoing SNB reduced the risk of death for patients with melanoma by 14% and reduced the risk of recurrence by 29%. These highly statistically significant results were consistent with the HR of MSLT-I and robust on sensitivity analyses thus providing strong evidence that SNB confers a true survival benefit. Patients with melanoma should be advised of this when the benefits and risks of SNB are being discussed with them.