When and where did dermatologic surgery begin? How did our modern practices originate? These intriguing and vexing questions are quite impossible to answer with any degree of confidence. Perhaps dermatologie surgery began early in the present century with William Halsted's detailed classic studies on tissue handling. 1 Some might select a date somewhere within the past 100 years when asepsis and local anesthesia first came on the scene. Perhaps some historians with a more retrospective lens might look back four centuries to the Renaissance surgeon, Ambroise Paré, who treated “poisoned” wounds with the “fat of puppy dogs” instead of boiling oil and controlled bleeding by grasping and ligating the severed ends of blood vessels. Other historians find the origins in ancient writings. In this brief chapter, I suggest that the origins of dermatologic surgery predate recorded history, and that ancient writings reveal surprising progress in this field. Because of limited space I shall offer only a few examples and speculations while trying to cover a very long period of time, from the Lower Paleolithic era until the time of Christ. Anthropologic data, written documents, and a limited amount of archeologie evidence will be presented. 2 Indications of skin surgery derived from iconographic sources will not be mentioned; neither will the fascinating surgical practices of contemporary primitive peoples, which by inference argue for the broad range of prehistoric surgical techniques. The history of specific instruments will be mentioned briefly.