In mycetoma, spread occurs locally and through the lymphatics thereby resembling sporotrichosis. Metastatic lesions may occur at various lymph node stations in which new satellites may develop. This phenomenon is more common in actinomycetoma, especially in cases with repeated surgery.
Haematological spread has also been described; M. mycetomatis and A. pelletierii grains have been detected in an intact blood vessel. In many spinal mycetoma, these lesions occurred without involvement of the skin or surrounding tissues suggesting haematogenousspread.