Outbreak of nontuberculous mycobacterial disease in the central Pacific.

Approximately 10% of the island population of Satowan (population, 650 persons), a small, remote coral island in the central Pacific, suffers from an acquired, chronic, disfiguring skin condition known locally as "spam." This skin disease has affected the island population since shortly after World War II. An investigation in 2007 revealed that this skin disease is caused by a nontuberculous mycobacterial infection closely related to Mycobacterium marinum. This article reviews the fascinating history of this skin disease on Satowan, its distinctive clinical presentation, and recommendations for diagnosis and treatment of clinically similar skin lesions in Pacific Islanders.