Leadership in extreme team contexts, such as polar regions, warzones, or high-altitude, is a critical determinant for these teams’ success and survival. Yet, research in this field remains fragmented, underscoring the need for an integrated perspective. To address this gap, we conducted an integrative conceptual review to advance theory and research, highlighting the role of transition and action phases in extreme team contexts leadership. Our review encompasses the full body of research on leadership in diverse extreme team contexts (e.g., firefighting, astronauts, healthcare, mining, etc.). From the initial 4,048 studies, we extracted a final sample of 166. We categorized the findings using a framework of team extremeness that differentiates task and environmental extremeness. This approach resulted in a nuanced classification of the extreme team contexts. Based on our findings, we present a dynamic framework of leadership in extreme team contexts, integrating aspects from situational leadership theory into the discussion. Our framework offers guidance for leading teams in extreme contexts that are characterized by intense shifts between recurring transition and action phases and differing contextual variables predicting leadership effectiveness. Finally, we provide recommendations for future research and practical guidance that significantly contribute to the understanding and application of leadership in extreme team contexts.