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A slowly developing necrotic ulcer with an undermined edge. Currently endemic in coastal Victoria, Far North Queensland and tropical regions of Africa. Refer early to an infectious disease unit. Diagnosis is by biopsy (the key test) and PCR testing. Usually treat with 8 to 12 wks of oral antibiotics (usually rifampicin and clarithromycin), along with specialist wound care. Surgical debridement may be necessary.