Cutaneous leishmaniasis (CL) is rare in Northern Europe, and most infections seen in Germany are contracted outside the country. [1–5] The "bite" of a sand fly is the vehicle whereby trypanosomes of Leishmania are introduced in the skin. In Northern Europe, CL is caused most commonly by Leishmania tropica. The typical clinical presentation of CL is a red-crusted nodule localized on face or extremities. Stereotypical changes of an acute lesion of CL are dense diffuse infiltrates of lymphocytes, plasma cells, and histiocytes with numerous gray-blue dots of Leishmania in the cytoplasm throughout the reticular dermis. Tuberculoid granulomas with very few organisms in the upper half of the dermis often impinging on the epidermis are said to be diagnostic of chronic lesions of CL. [6] Sometimes, CL presents with changes devoid of stereotypical features. We studied biopsy specimens of 30 patients with CL to demonstrate the spectrum of changes induced by leishmania in the skin. Specific attention was paid to unusual features that may mislead a dermatopathologist not to make the correct diagnosis of CL.