THE DIAGNOSIS of cutaneous granulomas has been complicated recently by the appearance of patients with cutaneous leishmaniasis, a disease hitherto rarely seen by American dermatologists. One case has been seen in the United States, and five have been discovered in Scotland. Cutaneous leishmaniasis is an endemic, papuloulcerative disease due to an infestation with a protozoal parasite, Leishmania tropica. The infection is limited to the cutaneous surfaces of the body and is self limited. It is known by various synonyms, some of which are Oriental sore, Biskra button, Delhi boil, Bagdad boil and salek. The last is a term used by the natives of Iran which, interpreted literally, means a ``small year." This name has been given to the disease because the lesions tend to heal spontaneously within eight to ten months. The causative organism was first discovered, described and photographed by Borowsky in 1897. It is morphologically similar to