Labowsky MT, et al. – The clinical implications of positive or negative direct immunofluorescence biopsies (DIF) in patients with clinically typical ocular mucous membrane pemphigoid (MMP) are analyzed in this study. They encourage clinicians and patients to consider treatment with systemic immunosuppression even in the absence of diagnosis confirmation by DIF. This study furthermore supports current standard of care to pursue a non–ocular biopsy of normal–appearing, perilesional skin or oral mucosa when possible.