Dermatologists commonly encounter lesions arising on the lips that require excision either for biopsy or treatment. These conditions can be benign, premalignant, or malignant. Examples of these conditions include hemangiomas, arteriovenous malformations, venous lakes, cheilitis glandularis, cheilitis granulomatosa, actinic cheilitis, Bowen's disease, lentigo maligna, malignant melanoma in situ, basal cell carcinoma, squamous cell carcinoma, and malignant melanoma, among others. This article will review several surgical techniques used for excision and repair of the lip in the treatment of these conditions. Our intent is to provide specific suggestions, without being dogmatic, in a spirit of practicality. Topics covered will include the importance of the lip, lip anatomy as it pertains to cutaneous surgery, techniques for obtaining lip anesthesia, partial-thickness lip excision, full-thickness lip excision, surgical vermilionectomy, and carbon dioxide laser vermilionectomy. Emphasis will be placed on those surgical techniques that involve excision and repair of conditions commonly encountered in a general dermatology practice. Extensive reconstructive procedures, reconstruction of Mohs micrographic surgical defects, and lip augmentation are beyond the scope of this article.