Surgical manipulation of the skin, mucous membranes, and nails is a large part of the practice of dermatology. Biopsies are performed to confirm clinical impressions or to make diagnoses that are clinically unclear. Lesions can be treated with cryosurgery, chemosurgery, laser surgery, and cold steel surgery. Cosmetic procedures are performed routinely by many dermatologists, dermatologic surgeons, general surgeons, plastic surgeons, otolaryngologists, ophthalmologists, and cosmetic surgeons. Similar techniques can be applied to the pediatric patient for correction of birth anomalies of the skin.

All dermatologists are trained to identify and treat skin lesions in both pediatric and adult patients. Some prefer not to perform biopsies or other surgical procedures on small children, but most treat all age groups. Today, however, many dermatologists treat only children. The Society for Pediatric Dermatology was established in 1975 and meets twice yearly to discuss unusual cases, management problems, and topics that are the cutting edge in pediatric dermatology. Issues in pediatric dermatologic surgery are commonly addressed, including tissue expansion, removal of congenital lesions, and laser treatment of hemangiomas and vascular malformations.

Physicians involved in the primary care of infants and children should understand differential diagnosis, natural history, and treatment options for dermatologic lesions. This understanding helps to ensure accurate diagnosis, referral (when necessary), and optimal treatment. In the first section of this article, basic office dermatologic surgery is addressed, including anesthesia choices, biopsy decision making and techniques, cryosurgery, and chemosurgery. The second section covers the decision-making process for choosing surgery in several dermatologic conditions in children, including congenital melanocytic nevi, aplasia cutis, nevus sebaceous, and port-wine stains.