title: Mohs micrographic surgery-induced pemphigus.
abstract: BACKGROUND
  Pemphigus is an autoimmune blistering disease that presents with flaccid intraepidermal blisters, erosions of the skin and mucous membranes, acantholysis, and in vivo bound and circulating autoantibodies against keratinocyte antigen. Currently a handful of reports incriminate surgical trauma as an initiating factor in this disease.
  
  
  OBJECTIVE
  To document pemphigus evolving in a wound after Mohs micrographic surgery.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We present a case of pemphigus that started in a Mohs surgical wound 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Internal Medicine, North-western University School of Medicine, Chicago, Illinois, USA.
authors.forename: M G
authors.initials: MG
authors.lastname: Duick
authors.forename: B
authors.initials: B
authors.lastname: Zaks
authors.forename: R L
authors.initials: RL
authors.lastname: Moy
authors.forename: R P
authors.initials: RP
authors.lastname: Kaplan
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000601:surgery; D005260:Female; D006801:Humans; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects*; D010392:Pemphigus / Q000209:etiology*; D012878:Skin Neoplasms / Q000601:surgery; D014945:Wound Healing