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A 74-year-old woman presented with a 30-day history of blisters and erosions in the oral cavity, trunk, and left eye conjunctival mucosa, also reporting a weight loss of 15 kg in the last 3 months. Histopathological examination showed subepidermal blisters and lymphocytic infiltrates with rare eosinophils in the superficial dermis. Direct immunofluorescence showed linear deposits of IgG and C3 along the dermal-epidermal junction and salt-split skin indirect immunofluorescence confirmed the presence of linear deposits of IgG along the blister floor. Indirect immunofluorescence revealed antibodies against laminin 332 using recombinant laminin 332 expressed in human HEK293 cells, and commercial ELISA kits (Euroimmun, Padova, Italy) did not reveal antibodies against BP230 and BP180 antigens. Anti-laminin 332 mucous membrane pemphigoid (MMP), a condition often associated with a hidden neoplasm, was diagnosed. In our case, the paraneoplastic nature of MMP was excluded. Thus, topical treatment with triamcinolone acetonide 0.1% in orabase once daily for 30 days, oral prednisone 0.75 mg/kg/day and rituximab were started to relieve symptoms. Conjunctival, nasal and oral erosions improved, as well as skin lesions, but later the patient was tracheotomized due to respiratory distress linked to the appearance of pharyngolaryngeal synechiae.

Introduction. The constant increase in the incidence of non-melanoma skin cancers (NMSC) makes their treatment a topic of paramount interest. Because most of NMSC tend to develop in visible areas such as head-neck area, it is a priority to choose the less destructive therapy and more appropriate reconstructive technique. Mohs Micrographic Surgery (MMS) represents the treatment of choice for skin tumors in critical sites, recurrent tumors and tumors with aggressive histologic features. Patients and Methods: We collected patients affected by NMSC who underwent MMS at the Dermatology Unit of IRCCS Fondazione Ca' Granda, Milan, in the period March 2017 - December 2021.Results. 159 patients were enrolled in this retrospective observational study. The excision margins were chosen based on a dermoscopic evaluation. The main histological diagnoses were basal cell carcinoma (145, 91.2%) and squamous cell carcinoma (10, 6.3%), in areas with high functional or anatomical value. 121 out of 159 surgeries did not require further enlargement after the removal of the clinically and dermoscopically visible lesion, but in 38 cases (23.9% of cases) the Pathologist required at least one subsequent enlargement, due to the persistence of neoplasm at the bottom or at the margins of the lesion. Only one recurrence has been reported so far. Conclusions: MMS is a pathology-controlled surgery with high intrinsic value because of the low risk of recurrences and should be routinely adopted for high-risk NMSC.