Mycetomas of the hand are a rare site of an uncommon disease, particularly in temperate climates. They are non-purulent inflammatory pseudotumours of mycotic origin. They are generally seen in Tropical Africa with a slow course progressing towards a phase of cutaneous fistula formation producing black, white or red grains depending on the fungus responsible. Ten cases are reported together with a review of the literature. Treatment must often be radical to prevent recurrence in the actinomycotic forms and this raises difficult problems of mutilating surgery of the hand for a benign and painless disease. However, ketoconazole has revolutionised the treatment of fungal varieties by allowing partial resections compatible with preservation of hand function.
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