Mohs micrographic surgery has emerged as a standard of care for excision of melanoma and melanoma in situ. Local control rates are as high as 97% at 5 years for both melanoma and melanoma in situ. Rapid immunohistochemistry (IHC) stains have brought greater accuracy to Mohs micrographic technique. Original immunohistochemistry stains utilized for melanoma Mohs surgery have included anti – HMB 45 and anti – S100. Given the slowness of those IHC stains (up to 80 minutes), new ultrarapid staining techniques have evolved. Anti – MiTF has dropped that time to 35 minutes. However, the most rapid technique so far has been the anti – MART 1 at 19 minutes and anti – melan A with Azure B at 12 minutes. Both stain the melanoma-associated antigen recognized by T cells – hence, the MART acronym. Compared to recurrence rates of 10-30% with traditional excision of melanoma in situ with 2 to 5 mm margins, Mohs with IHC using anti – Melan A and Azure B has brought greater accuracy and acceptable staining time.
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