<p>Subcutaneous local anesthetic injection is universally used in dermatologic surgery to achieve anesthesia. While multiple factors have been identified as influential in chronic pain, little is known about factors that contribute to acute pain. The purpose of this article is to elucidate trends and factors that contribute to the perception of acute pain. Patients scheduled to undergo Mohs surgery at our institution were surveyed regarding their anticipated, perceived, and recalled pain from local anesthetic injection prior to (“Before”), during (“During”), immediately after (“After”), and on the evening (“Evening”) of their procedure. Demographic data, relevant past medical history (PMH) and medication use, tobacco use, and prior history of Mohs surgery were collected from subsequent chart review. On average, pain intensities were significantly different between all four time points except between After and Evening. Patients with relevant PMH, patients who were having Mohs surgery on the head and neck, patients with no history of prior Mohs surgery, and never-smokers anticipated their pain to be greater than it actually was. Subsets of patients who anticipated their local anesthetic injection to be more painful than it actually was may benefit from increased anticipatory guidance and preoperative education.</p>