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Electrosurgery is a cornerstone of dermatologic surgery, yet it poses challenges in patients with cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter-defibrillators (ICDs). As CIED use increases, dermatologic surgeons more frequently face perioperative device management decisions, particularly the independent use of magnets to prevent electromagnetic interference (EMI). While some dermatologists report success with this approach, important questions persist around patient safety, scope of practice, and interprofessional collaboration. EMI from monopolar electrosurgery can transiently alter device function. In pacemaker-dependent patients, inhibition of pacing may result in bradycardia or asystole. In ICD patients, EMI may be misinterpreted as arrhythmia, causing inappropriate shocks or temporary loss of defibrillation functions. These risks, while infrequent, are well-documented and can be catastrophic when they occur [1]. Some dermatologists use magnets to temporarily disable defibrillation or modify pacing activity during procedures without cardiology input. However, not all CIEDs respond predictably to magnet application. Outcomes can vary based on the manufacturer, model, programming, and lead configuration. The 2024 AHA/ACC guidelines highlight the importance of confirming the specific CIED and assessing individual risk preoperatively [2]. It is thus important to remember that patient safety and avoidance of harm must predominate in perioperative device decisions. While equipped dermatologic teams can safely manage low-risk patients using magnets with appropriate protocols, this practice should be limited to cases with clear device history, confirmation of magnet effect, and documented electrophysiology backup when indicated. There is emerging evidence supporting carefully selected, independent dermatologic management of ICDs. A 2024 retrospective study of 33 dermatologic procedures in ICD patients found no adverse events or EMI when 21 cases were independently managed with magnets; high-risk patients were co-managed with electrophysiology [3]. Another study reported detectable EMI in procedures using monopolar electrosurgery but none when bipolar devices were used, suggesting that the latter is safer [4]. An emerging consideration is the increasing use of leadless pacemakers, which differ from traditional transvenous systems. These entirely intracardiac devices lack subcutaneous generators and transvenous leads, reducing circuitry that can facilitate EMI. Because most lack a hall sensor, they do not convert to asynchronous pacing with magnet placement, limiting the utility of magnet-based strategies [5]. In a small case series of patients undergoing procedures with monopolar electrosurgery, no evidence of EMI oversensing, pacing inhibition, or device reset was observed [5]. These findings suggest that routine preoperative reprogramming may not be necessary in low-risk cases. Overall, the literature suggests independent management may be ethically permissible in well-defined, low-risk scenarios with appropriate screening and safeguards. However, the limited scope and retrospective design of many studies underscore the need for caution and appropriate device team involvement. Ultimately, providers must weigh the convenience of independent management against the ethical duty to minimize preventable harm. As dermatologic surgery expands, interdisciplinary collaboration reinforces patient safety and professional integrity. The authors have nothing to report. The authors obtained consent from patients for their photographs and medical information to be published in print and online and with the understanding that this information may be publicly available. Dr. Tolkachjov is a speaker and investigator for CASTLE Biosciences, Kerecis, Boehringer Ingelheim, and Bioventus. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.