Cut with caution in cutaneous surgery: A resident’s guide to anatomical danger zones

Developing competence in the excision of benign and malignant skin lesions requires a sound understanding of local anatomy. Several functionally critical structures lie just beneath the skin and are vulnerable to injury during routine cutaneous surgery. Such injury results in functional loss, paresthesia, or troublesome hemorrhage that may obscure the operative field and compromise wound healing. We illustrate common superficial danger zones encountered during skin surgery. The article is organized by region; head and neck, upper limb, and lower limb, and outlines the surface landmarks, anatomical course, and resultant complication of iatrogenic injury, intentional or erroneously. The temporal branch of the facial nerve, superficial temporal artery, supraorbital and supratrochlear nerves, greater auricular nerve, extensor tendons, extensor pollicis longus, superficial branch of the radial nerve, great saphenous vein, saphenous nerve, and superficial peroneal nerve are discussed. The aim is to transpose anatomical knowledge into the operative field, familiarizing early years cutaneous surgeons with areas to be intentional with the identification, manipulation, and management of functionally important structures. Acknowledging these relationships facilitates safe excision, informed consent, and preservation of functional and esthetic outcomes in cutaneous surgery.