barry_g

Update:

Based on a highly respected recommendation, I traveled to Cambridge MA and had an excision with 5mm margins and reconstruction done by Dr. Stephen Sullivan. Melanoma excision with reconstruction is a specialty of Dr. Sullivan and he has done specific work/research with Dr. Frank Isik in Seattle (both are plastic surgeons) on exactly this. I highly recommend both these doctors. My procedure was done under local anesthetic only (by my request) and I was impressed with the degree of care Dr. Sullivan exercised during all phases of the procedure, and particularly during the reconstruction (fitting with my facial contours, suturing in such a way that the scar would be minimal and flat, etc etc)

I've been searching on the Web and from what I can tell, it appears that there are a select few doctors now performing Mohs surgery for melanoma in situ and that it's a fairly recent advancement. Here's an example of what I found: http://scopeblog.stanford.edu/2016/06/24/in-situ-melanoma-patients-now-eligible-for-quicker-procedure-at-stanford-medicine/

Do I have this right? This would seem a desirable option over blind 5mm margin excision, even if I had to travel for the surgery.  But I'm not sure these doctors are going to be easy to find.

Thanks!  The facial location is of major concern.

Thanks very much for a thorough explanation.  I will proceed with a plastic surgeon.