Background <p>Mycetoma is a chronic infection caused by fungi or bacteria that is endemic in tropical regions, but has been reported more frequently in immigrants in non-endemic countries. Diagnostic delays and therapeutic challenges are common. This review evaluates diagnostic difficulties, treatment, and outcome in immigrant populations.</p> Methods <p>PubMed and Embase were systematically searched using the following MeSH and keyword strategy: ((“Mycetoma“[Mesh] OR “Actinomycetoma“[tiab] OR “Madura foot“[tiab] OR “Eumycetoma“[tiab] OR Mycetoma)) AND ((“Emigrants and Immigrants“[Mesh] OR “Transients and Migrants“[Mesh] OR immigrant[tiab] OR emigrant*[tiab] OR migrant*[tiab] OR refugee*[tiab] OR Immigration[tiab] OR immigration)).* Two reviewers screened all records. Inclusion criteria were immigrant cases of mycetoma with extractable clinical data. Exclusions were non-immigrant cases, duplicates, and non-mycetoma infections. Twenty-nine studies met the criteria. The review followed PRISMA guidelines and was registered at the International Prospective Register of Systematic Reviews (PROSPERO), CRD420251144782.</p> Results <p>A total of 44 immigrant mycetoma cases were identified through the literature review (1974–2025), and one original case and one previously published illustrative case are presented. Most patients were male (81.8%) and experienced a mean diagnostic delay of six years. The lower limb was the most affected area (79.5%), and a third had bone invasion. Eumycetoma accounted for 61.4% of cases, predominantly due to <i>Madurella mycetomatis</i>. Surgery was performed in two-thirds of cases, with amputation in 9.1% and reconstruction in 10.5%.</p> Conclusion <p>These findings highlight diagnostic and therapeutic challenges in immigrant populations. Improved awareness, diagnostic tools, and research are needed to improve prognosis and reduce the burden of this neglected disease.</p> <p>Level of evidence: not gradable.</p>