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Updated: Aug 19, 2026
Granulocyte-dependent Autoantibody-induced Skin Blistering
Published on: October 12, 2012
Mohs micrographic surgery-induced pemphigus
1Department of Internal Medicine, North-western University School of Medicine, Chicago, Illinois, USA.
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.
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.
Insights
Mohs surgery may trigger pemphigus, an autoimmune blistering disease, in surgical wounds. This condition requires differentiation from typical wound healing complications.
Area of Science:
- Dermatology
- Autoimmune Diseases
- Surgical Oncology
Background:
- Pemphigus is an autoimmune blistering disease characterized by intraepidermal blisters and autoantibodies against keratinocytes.
- Surgical trauma is an infrequently reported trigger for pemphigus onset.
- Mohs micrographic surgery is a specialized technique for skin cancer removal.
Observation:
- A case report details pemphigus developing in a surgical wound after Mohs surgery for squamous cell carcinoma.
- Preoperative biopsy of the lesion did not indicate pemphigus.
- Postoperative biopsy confirmed pemphigus development within the Mohs surgical site.
Findings:
- Pemphigus manifested in the Mohs surgical wound post-excision of squamous cell carcinoma.
- The patient's preoperative lesion biopsy was negative for pemphigus.
- Histopathology of the postoperative wound confirmed the diagnosis of pemphigus.
Implications:
- Mohs surgery, similar to other surgical procedures, may act as a nonspecific trigger for pemphigus.
- Postoperative pemphigus requires careful differentiation from wound infections and other healing issues.
- This case highlights the potential for iatrogenic induction of autoimmune blistering diseases.
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