Excisional cutaneous surgery is performed commonly in patients who take medically necessary aspirin or warfarin. Although controversy has existed regarding the appropriate perioperative management of anticoagulant therapy during cutaneous surgery, recent data suggest that the risk of severe hemorrhagic complications is not increased if these medications are continued. Brief perioperative discontinuation does not lower this already minimal hemorrhagic risk. Furthermore, life-threatening thromboembolic complications have been related temporally to perioperative discontinuation of both aspirin and warfarin. In light of the absence of benefit and the presence of risks associated with discontinuation of warfarin and aspirin perioperatively during excisional cutaneous surgery, continuation of these medications is recommended in most situations. In all cases, the individual patient's medical history and risk factors should be taken into account when making this clinical decision, and deviation from the guidelines should be considered if clinical imperatives warrant.