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This is a fungal infection caused by dematiaceous (melanin-pigmented) fungi. It is rare in the US. Cauliflower-like lesions appear on the skin surface at the site of injury and the fungi then invade the local lymphatics; lesions also appear at skin sites served by the infected lymph ducts. Such infections are very difficult to treat and often necessitate surgery or amputation. Care must be taken to distinguish these from actinomycoses (bacterial origin) which may present similar clinical signs.