In endemic areas, subcutaneous masses should be considered as mycetoma until it proved otherwise. The clinical presentation, the aetiological agent, and the prevalence of infectious diseases that can mimic mycetoma influence the differential diagnosis of mycetoma.
The differential diagnosis of mycetoma includes many of the soft tissue tumours such as Kaposi's sarcoma, fibroma, malignant melanoma or fibrolipoma as well as thorn granuloma. The radiological features of advanced mycetoma may be comparable to osteogenic sarcoma and bone tuberculosis.
Primary osseous mycetoma is to be differentiated from chronic osteomyelitis, osteoclastoma, bone cysts and from syphilitic osteitis