Mohs Surgery & Skin Cancer
Melanoma
The Most Serious Skin Cancer — Expert Care in Alcoa, TN
Melanoma is the most dangerous form of skin cancer. While it accounts for only about 1% of all skin cancer cases, it is responsible for the vast majority of skin cancer deaths. The good news: melanoma detected in its earliest stage has a 5-year survival rate of approximately 99%. Awareness, early detection, and prompt surgical treatment are the most powerful tools we have.
What Is Melanoma?
Melanoma originates in the melanocytes — the cells responsible for producing the pigment melanin. Melanoma most commonly develops on areas with heavy sun exposure, but it can arise anywhere on the body — including on the back, legs, scalp, underneath the fingernails, and in locations rarely exposed to sun. This makes full-body annual skin exams especially important.
Recognizing Melanoma — The ABCDEs
Asymmetry
One half of the mole does not match the other
Border
Irregular, ragged, notched, or blurred edges
Color
Variation in color — shades of brown, black, red, white, or blue within the same lesion
Diameter
Greater than 6 mm (about the size of a pencil eraser) — though melanomas can be smaller
Evolving
Any change in size, shape, color, or new symptom (bleeding, itching, crusting)
The "ugly duckling" sign is equally important: any mole that simply looks different from all the other moles on your body — stands out from the crowd — warrants evaluation.
Types of Melanoma
Superficial Spreading Melanoma
The most common type (~70% of cases). Grows horizontally along the surface of the skin before eventually growing downward. Often appears as a flat or slightly raised discolored patch with irregular borders.
Nodular Melanoma
Grows vertically into the skin from the outset, making it one of the most aggressive subtypes. Often appears as a rapidly growing black, blue-black, or pink nodule. May bleed easily. Early recognition is critical.
Lentigo Maligna Melanoma
Develops from lentigo maligna — a flat, tan-to-brown irregular patch, most often on the face and sun-damaged skin of older adults. Mohs surgery (with immunohistochemical staining) and staged excision are preferred treatments.
Acral Lentiginous Melanoma
Found on the palms, soles, and beneath fingernails or toenails. More common in darker-skinned individuals. Often diagnosed at a later stage due to its location.
Amelanotic Melanoma
A particularly challenging variant that lacks pigment and can resemble a pink pimple, scar, or other benign lesion. Easy to miss — reinforcing the importance of biopsy for any unexplained non-healing or unusual lesion.
Staging & What It Means
Melanoma is staged from Stage 0 (in situ) through Stage IV (distant metastasis). The most important factor in the primary tumor is Breslow depth — the thickness of the tumor measured in millimeters.
Melanoma cells confined to the epidermis. Cure rate near 100% with surgery.
Thin tumors (< 2 mm) without ulceration. Excellent prognosis with wide excision.
Thicker tumors or ulcerated tumors. Wide excision and consideration of sentinel lymph node biopsy.
Spread to regional lymph nodes. Surgical removal of lymph nodes; adjuvant therapy discussed.
Distant metastasis. Systemic therapy (targeted therapy, immunotherapy) — significant advances in recent years.
Surgical Treatment of Melanoma
Wide Local Excision (WLE)
The standard treatment for melanoma is wide local excision with defined surgical margins based on tumor thickness. Current guidelines recommend 0.5–1 cm margins for melanoma in situ, 1 cm for tumors ≤ 1 mm, and 2 cm for tumors > 2 mm.
Mohs Surgery for Lentigo Maligna
Lentigo maligna (LM) and lentigo maligna melanoma (LMM) present a unique challenge: subclinical extension far beyond the visible lesion, often on cosmetically critical facial skin. Mohs surgery with rush permanent sections or immunohistochemical staining (MART-1/Melan-A) provides complete margin control. Dr. Skinner is experienced in this approach for appropriate LM and LMM cases.
Sentinel Lymph Node Biopsy (SLNB)
Recommended for melanomas > 1 mm thickness or with high-risk features. SLNB helps determine whether cancer has reached regional lymph nodes, guiding decisions about additional treatment.
Annual Skin Exams Save Lives
The majority of melanomas are found on routine skin exams. If it has been more than a year since your last full-body skin check, or if you have a changing or unusual mole, call us today.
(865) 268-4444