Local anaesthetic (LA) has long been an indispensable aid to dermatological practice. With the development and expansion of dermatological surgery as a subspecialty within dermatology, and the increasing complexity of procedures being undertaken by clinicians, it would seem reasonable to assume that the volume of LA being used in dermatology departments has increased. Although the volumes of LA used in individual patients are likely to be small, the potential for toxicity still exists. An inadvertent intravascular injection in a highly vascular area such as the head and neck may produce toxicity; a small, light patient or one with an irritable myocardium may have a lower threshold for developing LA toxicity. As with all drugs, dermatologists are responsible for the safe use of local anaesthetic in clinical practice, a responsibility that demands a knowledge of the mechanism of action, the available preparations and the recommended dose, an awareness of the early signs of toxicity, and a theoretical knowledge of how to manage toxicity.