Abstract: Leprosy is now very rarely acquired in Australia, but it is still diagnosed; Indigenous Australians in remote locations bear the greatest burden of disease. Historically, its incidence has been highest in the Northern Territory, but cases are also diagnosed in Far North Queensland (FNQ), a region that adjoins Papua New Guinea (PNG), where leprosy remains endemic. Since 1985, Torres Strait Islander Australians and PNG nationals have been able to move freely across the border to pursue traditional activities in the Torres Strait Protected Zone. This arrangement acknowledges the importance of their shared cultural history, but also means that FNQ clinicians may encounter conditions that are rare in temperate Australia. The potential public health implications are also clear. To evaluate the epidemiology of leprosy in FNQ, we retrospectively reviewed all laboratory-confirmed cases diagnosed in the region during 1989–2018. The Far North Queensland Human Research and Ethics Committee provided ethics approval for the study (reference, HREC/18/QCH/107). Twenty cases of leprosy were identified in the Queensland Health Notifiable Conditions Register (Box 2). The median age of the patients was 26 years (interquartile range, 16–36 years); 11 patients had been born in Australia, including seven of nine Torres Strait Islanders (but no Aboriginal Australians). Apart from 1989 (six cases) and 2017 (three cases), no more than two cases had been notified in a single year. The most recent Australian-born patient was a 28-year old Torres Strait Islander woman diagnosed in 2009; she had had close contact with a person with leprosy born in PNG.