A 76-year-old female presented with a darkening patch on her right lower cheek. It began as a light tan spot that grew more irregular in shape with focal dark streaks. A biopsy revealed malignant melanoma in situ, a type of shallow melanoma skin cancer. Because a standard surgical excision would have created a much larger wound on the face, Mohs micrographic surgery was used to keep the wound as small as possible but remove all of the cancer confidently. Facial plastic reconstructive surgery was performed the same day to stitch close the gap left by the melanoma, hiding scar lines along the nasolabial fold (cheek-mouth crease). 8 weeks after surgery, the scar is difficult to see and she has full function of her mouth.