Mohs and Immunofluorescence for Malignant Melanoma In Situ

Inclusion Criteria: 1. Male or female of any race and at least 18 years of age 2. Patient with biopsied proven Lentigo maligna (LM) in situ 3. Patient meets criteria for Mohs Micrographic Surgery (MMS) 1. The cancer is large 2. The edges of the cancer (clinical margins) cannot be clearly defined 3. Prior treatment has failed, i.e. recurrent tumor 4. The cancer is located in a cosmetically sensitive or functionally critical area of the body (such as eyelids, nose, ears, lips, fingers, toes, and genitals) 5. The histologic pattern of the cancer is aggressive 6. The patient is immunosuppressed 4. Patient with biopsied proven LM in situ located on an anatomic areas appropriate for MMS: 1. Area H: ''Mask areas'' of face (central face, eyelids \[including inner/outer canthi\], eyebrows, nose, lips \[cutaneous/mucosal/vermillion\], chin, ear and periauricular skin/sulci, temple), genitalia (including perineal and perianal), hands, feet, nail units, ankles, and nipples/areola. 2. Area M: Cheeks, forehead, scalp, neck, jawline, pretibial surface. 3. Area L: Trunk and extremities (excluding pretibial surface, hands, feet, nail units, and ankles). 5. Patient able to tolerate surgery 6. Patient is able to comply with appointments including follow-up appointments 7. Ability to understand and willingness to sign a written informed consent document Exclusion Criteria: 1. Patients under the age of 18 2. Patient does not meet criteria for MMS or has LM located in areas that are not accessible with MMS 3. Patient with previously diagnosed invasive LM 4. Patients unable to comply with follow-up 5. Adults unable to consent 6. Pregnant women 7. Prisoners