A child may present to plastic surgery for treatment of a wide range of cutaneous lesions. Accurate clinical diagnosis of any skin lesion prior to considering excision results in an optimal outcome. This review discusses the most common papular and nodular skin lesions in children and addresses indications for removal as well as relative contraindications, alternative treatment options, and necessary further diagnostic work-up. Lesions are classified into five categories: expected spontaneous regression without treatment intervention; elective surgical removal guided by clinical circumstances, with a subgroup of these indicating possible underlying syndromes; further diagnostic imaging indicated prior to treatment intervention; and malignancy requiring complete surgical removal or adjuvant therapy (Fig. 1).