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Leprosy is an infectious disease characterized by slow and chronic evolution, caused by Mycobacterium leprae and or Mycobacterium lepromatosis, an intracellular alcohol-acid-resistant (BAAR) bacillus. The objective of this study was to provide an epidemiological, clinical, and geographic characterization of leprosy in the city of Santarém-Pará during the period 2011–2020. A cross-sectional, descriptive, and quantitative approach was used, employing maps and tables to illustrate clinical and epidemiological variables, including: sex, age, race, area of residence, operational classification, clinical form, number of skin lesions, number of affected nerves, and health units. During the analyzed period, 581 cases of leprosy were diagnosed, resulting in the following cumulative incidence rates: male (60%); age over 15 years (94%); urban area (73%); multibacillary (74%); borderline form (46%); skin lesions greater than 5 (34%); and no nerves affected (68%). In the urban perimeter, a higher cumulative incidence of cases was observed in the central area with 133 cases. However, the health unit reporting the largest number of cases belonged to the southern area, specifically the Basic Health Unit of Nova República, with 48 cases. This study highlights the need to characterize the nuances of leprosy and its variability within the urban environment, according to different areas. Further research is essential to inform the implementation of public policies aimed at addressing the population with the highest vulnerability index, thereby reducing leprosy rates in Santarém. Author summary: This article addresses the incidence of leprosy in Santarém, Brazil, during the COVID-19 pandemic. In 2020, there was a 41% reduction in cases compared to the average between 2015 and 2019, possibly due to the cancellation and rescheduling of appointments, affecting diagnoses and follow-up. Men constituted 60% of the cases, with their hesitation to seek care associated with late diagnoses. Alarmingly, 6% of patients were under 14 years old, indicating possible intrafamilial transmission. Socioeconomic and ethnic inequalities were evident, with 74% of cases in individuals of mixed race. The article emphasizes the importance of addressing leprosy not only as a public health challenge but also as a reflection of social and economic inequalities in Brazil. It proposes comprehensive health policies, expansion of medical services in remote regions, and educational initiatives for awareness and early diagnosis, especially in vulnerable communities. The association between age and clinical form of the disease, as well as spatial distribution analyses, provides crucial insights for developing targeted prevention and treatment strategies. [ABSTRACT FROM AUTHOR]