title: Mohs Surgery in Patients Immunobullous Diseases: Should Prednisone be Increased Prior to Surgery?
abstract: BACKGROUND
  Mohs surgery is one of the most effective treatment options for skin cancers as it offers one of the highest chances for cure. Mohs surgery is a precise technique that removes a layer at a time. Although this may be advantageous, this treatment method is difficult in patients with immunobullous diseases. Currently the guidelines for Mohs surgery do not discuss the premanagement of immunobullous patients about to undergo Mohs surgery.
  
  
  OBJECTIVE
  To advocate for increasing prednisone dose in patients with immunobullous disease prior to undergoing Mohs surgery.
  
  
  METHODS
  The authors present a case of an excision of a squamous cell carcinoma from a 94-year-old woman with a history of pemphigus vulgaris using Mohs micrographic surgery.
  
  
  CONCLUSIONS
  Current preoperative guidelines for Mohs surgery do not address the issue of altering steroid medications for patients with immunobullous disease prior to the procedure. The authors suggest that patients with a history of immunobullous disease undergoing Mohs micrographic surgery should have an increase in steroid dose prior to surgery.
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine/Broward General Medical Center, Ft. Lauderdale, Florida;
authors.forename: Justin
authors.initials: J
authors.lastname: Rubin
authors.affiliation: Largo Medical Center, Largo, Florida;
authors.forename: Khasha
authors.initials: K
authors.lastname: Touloei
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine/Broward General Medical Center, Ft. Lauderdale, Florida;
authors.forename: Tracy
authors.initials: T
authors.lastname: Favreau
authors.affiliation: Mount Sinai Medical Center, Miami Beach, Florida.
authors.forename: Martin
authors.initials: M
authors.lastname: Zaiac
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine/Broward General Medical Center, Ft. Lauderdale, Florida;
authors.forename: Shino
authors.initials: S
authors.lastname: Bay