Mohs micrographic surgery-induced pemphigus

BACKGROUND. Pemphigus is an autoimmune blistering disease that presents wit h flaccid intraepidermal blisters, erosions of the skin and mucous membrane s, acantholysis, and in vivo bound and circulating autoantibodies against k eratinocyte antigen. Currently a handful of reports incriminate surgical tr auma as an initiating factor in this disease. OBJECTIVE. To document pemphigus evolving in a wound after Mohs micrographi c surgery. METHODS. Case report. RESULTS. We present a case of pemphigus that started in a Mobs surgical wou nd after the excision of a squamous cell carcinoma (SCC) from a 49-year-old woman. Biopsy of the preoperative lesion did not reveal pemphigus. Biopsy of the postoperative lesion revealed pemphigus with no residual SCC. CONCLUSION. We suggest that Mohs surgery, like any other skin surgery, may nonspecifically activate pemphigus. This change must be differentiated from postoperative wound infection and other causes of poor wound healing.