A 59-year-old Malay man presented with a keratinising lesion over the dorsum of right toe. The resected specimen was an ulcerated necrotic skin covered lesion that measured 5 x 2.5 x 2.5 cm. The cut surface showed blackish powdery granular material embedded in nonviable tissue (Panel A; Haematoxylin and Eosin stain, B; Grocott (Silver) stain and C; Periodic Acid Schiff [PAS] stain). What is the diagnosis? Answer: refer to page 238

(Refer to page 210) Answer: Eumycetoma (Madurella mycetoma or Maduramycosis) Mycetoma is an uncommon localised chronic infection of the skin and subcutaneous tissue that can be due to fungus (eumycetoma) or bacteria (actinomycetoma). It is characterised by a triad of tumefaction, draining sinuses (usually in late stage) and presence of the exudates containing colonial grains. Mycetoma infection is classified based on the aetiological agents and colour of the grains (Refer to supplementary text).