Safety of Local Anesthesia in Pediatric Dermatologic Surgery: Our Experience and a Concise Review of the Existing Literature

Introduction: Pediatric dermatologic surgery is important for both diagnosis and treatment, including excision of suspected cutaneous neoplasms. While general anesthesia and deep sedation are well studied in this setting, evidence on the safety of local anesthesia is more limited. Objectives: To evaluate the safety of local anesthesia in pediatric dermatologic surgery and compare our findings with a concise review of the literature. Methods: We conducted a single-center retrospective study of 678 children who underwent skin biopsy or excision with histopathologic diagnosis at the Pediatric Dermatology Unit, University of Bologna, Italy, between 2018 and 2023. Data on age, procedures, anesthetic techniques, and adverse events were collected. A concise PubMed review up to April 3, 2025 included English-language human clinical studies on local anesthesia in pediatric dermatologic surgery. Results: The cohort included 678 children (342 males, 336 females) aged 1 month to 14 years (mean age, 9 years), undergoing 516 biopsies and 162 excisions. All received topical anesthesia, and 617 also received infiltrative anesthesia. No local or systemic adverse reactions occurred after infiltrative anesthesia. Three mild cases of localized purpura were observed after occlusive lidocaine-prilocaine cream, all resolving spontaneously. Thirty-six children were referred for sedation or general anesthesia, mainly because of poor compliance or the need for wide excision. The literature review identified five studies including 1322 children; no systemic adverse effects were reported. Conclusions: Pediatric dermatologic surgery can be safely performed in an outpatient setting under local anesthesia. Age, procedure type, and child and parent compliance should guide anesthetic choice.