Histopathological examination of a biopsy from the involved area may be extremely useful in arriving at a definitive diagnosis of mycetoma. This material is known to be of proteinaceous and lipid nature and is frequently seen at the periphery of an aggregate of organisms, but is not specific to mycetoma infections. Around the granules, collections of polymorphonuclear cell-forming microabscesses are seen. At the periphery, ill-formed granulomas with giant cells may be noted. In long-standing lesions, fibrosis is prominent and the granules are scanty.
Surgery is of prime importance in the treatment of mycetomas, regardless of the causative agent.
Wide surgical debridement is needed when large areas are involved and local excision is the treatment of choice in small lesions. Actinomycetomas respond better to therapy than eumycetomas. In the former, prolonged penicillin therapy is given, but in case of allergy to penicillin clindamycin or streptomycin may be used. Mycetomas are known to have a worldwide distribution, however, a predilection for the tropics is well documented. Africa, the tropical and semi-tropical areas of South America, India and Southern Asia are areas where mycetomas have been reported most frequently.