Melty Blood: Act Cadenza is a version of Melty Blood based on the arcade conversion of the same name. The main difference from the original PC game is the elimination of the story mode with its visual novel-style gameplay; this release consists entirely of 2D versus fighting, utilizing characters from Tsukihime and its sequels.

It completely revamped Aoko Aozaki's movelist for use as a playable character, and introduced Kouma Kishima into the series, a man who was deeply involved in Shiki Tohno's past. It also introduced the Shielding mechanic (separate from EX-Shielding), as well as including various changes to the properties of characters. This version (as well as the later released Ver. A) can be identified by the Atlasia crest, and the phrase "Through the Looking-Glass, Black Light transparently", both present in the logo.