Dermatologic surgery and the pregnant patient.

Background: Because of concerns about potential harm to the mother or fetus, dermatologic surgeons are frequently hesitant to perform cutaneous surgery on pregnant patients.

Objective: To review the relevant physiologic changes during pregnancy, appropriate preparation for and timing of procedures, and drug safety.

Methods: A literature review was performed of dermatologic and nondermatologic journals discussing physiology, surgery, and drug safety in the pregnant patient.

Results: Special positioning is required for the pregnant patient during surgery. Low doses of most local anesthetics with epinephrine as well as nitrous oxide less than 50% are safe to use during pregnancy. Sedatives and opioids are potential teratogens and should be avoided. Safe antibiotics to use during skin surgery in pregnancy include penicillins, cephalosporins, and nonestolate erythromycin. If necessary, lymph node dissections under general anesthesia in the pregnant melanoma patient should occur during the second trimester.

Conclusion: With appropriate preparation, safe and successful cutaneous surgery can be performed on the pregnant patient.