“I've had this sore on my chin for twelve years. It never heals. Can you help?” asked a fifty-four-year-old man. Ordinarily, a sore that does not heal is a skin cancer. But, three skin biopsies taken of the sore never showed any evidence of cancer. Nor was there any evidence of a draining sinus from an infected tooth. In fact, he had had excellent dental care with annual x-rays of his teeth, all totally normal.

Here was a man in excellent health with a sore that waxed and waned, but never completely healed. We secured a fourth skin biopsy and did bacterial and fungal cultures. Again, there was no cancer or other definable skin disease, such as scarring lupus erythematosus. There were also no pathogenic bacteria present or any evidence of the actinomycetes which cause the chronic ulceration of actinomycosis. X-ray of the jaw showed no osteomyelitis or other bone change. Again, the biopsy showed only nonspecific inflammatory changes.

The sore was never itchy, but our patient readily admitted to picking at the spot, trying to remove the crusts and debris. Sometimes, he felt that underlying ingrown hairs were responsible. We wondered if his constant picking of the chin could be a compulsive tic. This proved not to be the case, as psychotropic drugs had no effect.

At the time of his first visit, the sore was an open ulcer about a quarter of an inch in diameter.