Impact of Immunostaining in Mohs Surgery

The presentation by Dr. Dan Lewis, an assistant professor and Mohs surgeon, addresses the significance of immunostaining (IHC) in Mohs surgery. He emphasizes the challenges surgeons face in visualizing tumors, particularly those with subtle histological features, drawing a parallel to the difficulty of spotting faces within coffee beans. IHC supplements routine H&E staining, enhancing the identification of high-risk squamous cell carcinomas (SCC) and specialty site melanomas by improving tumor visualization and reducing uncertainties. For high-risk SCC, where complications and recurrence rates can be high, IHC can lower local recurrence rates significantly. Dr. Lewis illustrates the effectiveness of IHC stains like AE1AE3 in identifying tumors that may be missed on traditional slides, especially in cases of single-cell spread or perineural invasion. In melanomas, IHC also proves crucial, with specific stains such as Mart-1 improving tumor detection and lowering recurrence rates to approximately 0.49%. Additionally, the use of IHC simplifies surgical procedures by resulting in fewer surgical stages and smaller defect sizes, thus lessening patient burdens in terms of time and cost. Overall, the benefits of immunostaining in Mohs surgery are evident, leading to better patient outcomes and increased surgical efficiency.