Surgical management as initial treatment for cutaneous leishmaniasis: An example using a case of Leishmania panamensis infection.

Cutaneous leishmaniasis is a parasitic infection caused by intracellular protozoa of the genus Leishmania1. It is endemic to over 70 countries, with more than 30 sandfly species identified as vectors1. Leishmania panamensis is a major cause of disease in Central and South America1. The cutaneous form typically presents as chronic granulomatous papules or plaques on the face, arms, or legs, which may be nodular or ulcerative and can persist for years, often leaving disfiguring scars1.Treatment generally involves systemic antimonials such as sodium stibogluconate or alternative agents including pentamidine, amphotericin B, and paromomycin2-4. Surgical management is typically reserved for cosmetically sensitive areas or refractory lesions5-6. We present a case of L. panamensis infection with a large ulcerated plaque that progressed despite initial surgical intervention, ultimately requiring systemic antimicrobial therapy7.