Dermatologic surgeons make clinical decisions based on sound scientific evidence whenever possible. In the case of choosing surgical instruments, no such evidence exists. Experience gained from training programs and discussion with colleagues will enter into the decision process. However, a surgeon needs only to peruse any instrument catalogue to see that the multitude of available instruments can be bewildering. Ultimately, which instrument works best for a given surgeon is largely a matter of personal preference. As such, this article will distill the choices down to the essential tools for the dermatologic surgeon to skillfully perform excisional surgery on the skin. Brand names (such as Bard–Parker and Beaver, Becton Dickinson AcuteCare, Franklin Lakes, NJ) that have entered into common parlance will be used for convenience, but do not necessarily imply an endorsement of these products.