Primary malignancies of the skin are uncommon in childhood. A low index of suspicion may lead to a delay in diagnosis. This paper reviews the most common pediatric primary skin tumors: melanoma, squamous cell carcinoma, and basal cell carcinoma. Because almost all skin cancers in children occur in the setting of a predisposing condition, identifying children at greatest risk is crucial to their management. Important precursor lesions and syndromes are stressed.