Mycetoma is a tropical superficial fungal infection endemic in parts of Africa. It affects the foot and leg commonly, but any part of the body may be involved. Mycetoma presents with characteristic discharging sinuses containing fungal granules, a picture that is pathognomonic. However, the disease may present without these characteristic features, thus causing diagnostic difficulty with other chronic granulomatous infections such as tuberculosis or benign skin lesions.A review of four male and three female patients aged 28-70 years with mycetoma seen during a six-year period.The duration of the lesion before presentation was between two and six years (median five years). Clinical presentation included pigmented cutaneous nodules, depigmented spots, multiple discharging sinuses, or a fungating mass with bone erosion, involving almost any part of the body (face, trunk, and leg). The range of clinical misdiagnoses included skin tuberculosis, fibroma, amelanotic melanoma, basal-cell carcinoma, and brain tumor. Histologic examination of tissue biopsies showed amorphous aggregates of eosinophilic granules in a background of chronic suppurative inflammation.Mycetoma is a disease with sporadic occurrence in our environment. The presentation and clinical course may be confused with those of many skin diseases. Knowledge of mycetoma pathology is important for prompt diagnosis and treatment of this indolent clinical entity.