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In the period from 1984 to 2016, we observed 16 patients in whom a clinical diagnosis of mycetoma was made. In 8 patients (6 males and 2 females, with an age ranging from 6 to 59 years [mean age: 37.1 years]), this diagnosis was confirmed by histopathological, mycological, and bacteriological examinations. In 2 patients, it was possible to perform polymerase chain reaction (PCR). The histopathological picture was superimposable in all patients. It showed suppurative granulomas surrounding characteristic grains in the deep dermis and subcutis ( Fig. 1 ). In particular, granulomas were composed of neutrophils, histiocytes, and lymphocytes. In actinomycetomas, thin filamentous bacteria were present ( Fig. 2 ); in eumycetomas, eosinophilic structures containing hyphae and spores were observed ( Fig. 3 ). Complete patients’ characteristics and etiological agents are reported in Table 1 . In 2 cases, the infection was acquired in India, in 2 in Ethiopia, an in 1 case each in Senegal, Tanzania, Honduras, and Italy. Etiological agents were identified in 6 patients: Actinomadura madurae and Madurella mycetomatis in 2 patients; Aspergillus nidulans and Phialophora verrucosa in 1 patient; in 2 cases the infection was caused by Acremonium spp. and Fusarium spp. In 5 patients, mycetoma involved the foot; the buttocks, thigh, and ankle were involved in 1 patient each. Mycetomas are chronic and deep infections of the skin caused by bacteria (actinomycotic mycetomas or actinomycetomas) [1, 2] or fungi (eumycotic mycetomas or eumycetomas) [1, 3] . The latter are observed mainly in Sub-Saharan Africa, whereas actinomycotic mycetomas Published online: January 17, 2018

Mycetomas: The Experience of the Dermatology Unit of the University of Milan