Author: David Hagebush
Melanoma tissue on frozen section with H&E staining and MART-1 staining.
In an important article Melanoma Treated With Mohs Micrographic Surgery Using a Novel-Modified 15-Minute Mart-1 Immunostain: Discussion of Technique and Experience published in Dermatologic Surgery, a group of clinicians from Minnesota were the first to report their success adapting and utilizing the rapid ihcDirect Mart-1 for melanoma in situ and invasive melanoma.
The article highlighted some of the benefits and challenges of adapting and performing very fast immunohistochemistry testing in a clinical setting. The team described their process of adapting the assay to fit their needs and achieve College of American Pathologist quality standards. The authors stated “this novel-modified 15-minute MART-1 IHC protocol allows Mohs surgeons the luxury of integrating MMS (Mohs Micrographic Surgery) for melanoma into their daily practice due to its rapidity, ease of use, and nonreliance on expensive IHC machinery.”
Background: “MART-1 stains are frequently used during MMS for melanoma because they allow for enhanced visualization of melanocytes, and its use has been associated with improved outcomes including local recurrence rates of <0.5% in MIS and invasive melanomas. Standard MART-1 IHC tests can take over 2 hours to perform and may require the use of specialized machinery.” The authors described how the limited number of steps and ease of use of the ihcDirect assay were also an improvement over other assays currently on the market.
Some Details: The study was thorough and ran for over 14 months. It included all patients with MIS or invasive melanoma treated by a single Mohs surgeon with MMS. The MART-1 IHC protocol was validated as it was applied to stained normal melanocytes, sun-induced melanocytic hyperplasia, and malignant melanoma. The assay had acceptable concordance when compared with permanent sections stained with a standard MART-1 protocol. Over this period of time, 155 melanomas were treated using the modified protocol.
In conclusion, the authors stated that they were optimistic that their novel 15-minute MART-1 IHC protocol for MIS and invasive melanoma would assist in increasing the accessibility of MMS with MART-1 immunostaining as it is rapid, inexpensive, and easy to use.
To learn more, select the enclosed link Am Soc for Dermatology Surgery.
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