Carolina has pemphigus. Her nose peels a lot during the winter months. The vet looked at her nose and said pemphigus, no biopsy needed. She was given a topical cream and prescribed niacinimide. She was diagnosed in the winter of 2004-2005. She has no issues with breathing. We carefully check the other areas where skin meets fur (eyes, toes, mouth, girl plumbing, etc.), since if it was to spread that is where it would go to. Knock on wood we haven't had any other issues.
Get a second opinion, I don't think a biopsy is necessary for a diagnoses. Niacinimide isn't going to hurt him, why not try and see what happens.