Cutaneous surgery and the pregnant patient

Nevi and pregnancy

“…While no adverse events have been documented in humans, studies in sheep and in vitro studies with human uterine arteries have shown that epinephrine at high doses can cause spasm and reduce flow through the uterine artery. [23][24][25] For this reason, many advise to use lidocaine without epinephrine in pregnant patients. 26 Lidocaine with epinephrine is actually classified as FDA category B, and while there are no studies supporting this, the likelihood of significant effect on the fetus is low.…”

“…Serum levels of endogenous epinephrine during a stressful event exceed serum levels caused by injections of lidocaine with epinephrine. 24 The addition of epinephrine to lidocaine for obtaining a biopsy specimen in a pregnant patient may actually provide an advantage 27 in that its vasoconstrictive effects can reduce peak serum levels of lidocaine in the mother, and therefore decrease placental transfer of lidocaine to the fetus. 24 In conclusion, based on the available evidence, changes that occur in a nevus of a pregnant patient should not be disregarded as a physiologic consequence of pregnancy.…”

Hormones, nevi, and melanoma: An approach to the patient

“…Epinephrine is classified as a category C drug according to the FDA and in animals has the potential to decrease uterine blood flow. 48,49 It has been suggested that epinephrine can be used safely in pregnancy, if used cautiously, 50 perhaps best at a concentration of 2.5 to 5.0 g/mL, or the equivalent of 1:400,000 or 1:200,000 concentration, respectively, when mixed with lidocaine, if larger doses of lidocaine are anticipated. 50 If sentinel lymph node (SLN) mapping and biopsy may be indicated, it becomes much less clear as to the safest way to perform this technique in the pregnant woman.…”

Dermatologic surgery and cosmetic procedures during pregnancy and the post-partum period

“…Hexachlorophene is not considered as efficacious as other available agents, although it was used extensively in the past in pregnant women and neonates with little reported toxicity if not used on open skin or in high concentration (10,11). It does have known central nervous system toxicity which has lead to seizures and death when used in the neonatal setting (3,9). This has lead to its abandonment during pregnancy and in the neonatal period.…”