Abstract
Facial and head and neck skin lesions are usually obvious to patients and others, and advice is often sought as to their nature, with cosmetic removal of benign lesions regularly requested. Premalignant and malignant skin lesions are increasing in incidence, and this is related to sunshine exposure, an ageing Caucasian population, along with increasing numbers of patients who are immunosuppressed. Important surgical anatomical considerations in skin surgery relate to appropriate curative resection margins, specifically where the deep margin may involve or be close to important underlying structures. Suspected melanoma should undergo narrow excision biopsy where direct closure is possible. Closure can be by purse string, and any ellipse should be short, to preserve proximal lymphatic channels. Consider closure of the primary defect without the darts of an ellipse in thick skin. Closure of skin should be in layers with deep resorbable sutures to close any dead space and oppose the deep dermis.