<p>Squamous cell carcinoma (SCC) of the hard palate and maxillary alveolus is a rare but aggressive subtype of oral cancer, often diagnosed at an advanced stage due to its concealed anatomical location and lack of early symptoms. Its closeness to vital structures complicates both diagnosis and surgical management. This systematic review intends to assess survival rates and key prognostic indicators in patients with SCC of the hard palate and maxillary alveolus - treated surgically, with or without adjuvant treatment. 15 eligible studies were identified from a systematic search, conducted following PRISMA 2020 guidelines. Data on overall survival (OS), disease-specific survival (DSS), disease-free survival (DFS), recurrence patterns, and treatment modalities was analyzed. Study quality was assessed using the Newcastle–Ottawa Scale. Five-year OS rates ranged from 30.3% to 88%, with poorer outcomes in T4 and node-positive cases. DFS was as low as 27.3% in some cohorts. Factors such as tumor size, nodal involvement, positive surgical margins, perineural invasion, and poor histological differentiation were consistently associated with worse prognosis. Surgical resection remained the primary treatment, and the role of elective neck dissection (END) is unclear, especially in early-stage disease. SCC of the hard palate and maxillary alveolus is associated with late presentation and variable survival outcomes. Prognosis depends largely on tumor stage and pathological features. More prospective studies are needed to standardize treatment strategies and clarify the role of END, while also focusing on long-term functional outcomes and quality of life.</p>