As specific data and studies concerning perioperative antibiotic prophylaxis in dermatologic surgery are scarce, recommendations to date mainly draw on findings from other medical disciplines and use them analogously. Three main factors are essential in the decision process: 1st How contaminated is the wound (or will it be)? 2nd Where is the lesion located and what kind of procedure is intended? 3rd Is the patient among the highest risk group for endocarditis? An algorithm is presented incorporating these key features. The preferred antibiotic for perioperative prophylaxis is a first generation or second generation oral cephalosporin, a beta-lactamase resistant penicillin (isoxazolyl penicillin) or amoxicillin/clavulanic acid. The prophylaxis is administered in the highest possible single dose within 2 hours before and 3 hours after surgery. Penicillin or cephalosporin can be substituted with clindamycin or erythromycin in case of known drug allergies. There is insufficient data on the pros and cons of preoperative hair removal. Should hair removal be necessary, clipping is preferred to shaving.