This form of Cutaneous leishmaniasis is seems to start forming lesion 6 months ago. At first time some fundamental questions should be answered by patient. We need to know about the source of diseases, about the biography and travel history.

Sampling must be done from the margin of the lesions, and the sample should be asses using parasitological and molecular techniques. For differentiation i recommend RFLP-PCR method.

I think a microscopic analysis of a sample(biopsy) from affected area may also confirm the presence of Leishmania parasite (economic and quick method). Here in India, dermatologists use Sodium stibogluconate to successfully treat cutaneous leishmaniasis. 1 injection on the affected site on alternate days for 3 times, then on the next month 3 more injections (if some parasites are still there). The injection will be very painful, however will cure the disease.

Here in Brazil, municipality of Ananindeua State of Pará-Instituto Evandro Chagas, we made the diagnosis based on clinical evaluation, in which we observed characteristic of the lesions, in the most classic case, which resembles this lesion: ulcerated cutaneous lesion of high borders, grainy and painless background; epidemiological evaluation: was present in the area of ​​cutaneous leishmaniasis transmission, time of evolution .... and laboratory diagnosis ranging from simple direct parasitological method (scarification of the lesion edge and smear confection) depending on the time of evolution, because some species of Leishmania present a low parasitic load, and / or lesion biopsy for molecular examinations (PCR-RFLP) and immunological test, which evaluates the individual's late cellular hypersensitivity response.

Dear Bahman rahimi esboei, Marliane Batista Campos, thanks for your excellent comments. I appreciate your viewpoints.