PERSISTENT INFECTION OF THE CHIN WITH AN UNUSUAL SKIN PATHOGEN (STREPTOCOCCUS-MILLERI) - A SIGN OF INTRAORAL CARCINOMA

Streptococcus milleri is a commensal of the oropharynx and gastrointes tinal tract which is not generally associated with skin disease. We no w report a patient who presented with a pustular mass of the chin with lower lip anaesthesia. He was initially thought to have sycosis barba e, but response to treatment was poor and lesional swabs repeatedly cu ltured S. milleri. After some delay squamous cell carcinoma of the mou th, involving the mandible and overlying skin, was detected. We consid er that the S. milleri either invaded through the tumour from the mout h or root canal or colonized the skin from saliva dribbled over the nu mb lower lip. Isolation of an unusual organism and numbness of the chi n are features that should suggest the need for early radiography.