Over 95% of the global burden of Buruli ulcer disease (BU) caused by Mycobacterium ulcerans occurs in equatorial Africa. National and sub-national programmes have implemented various approaches to improve detection and reporting of incident cases over recent decades.Regional incidence rates are currently in decline, however, surveillance targets outlined in 2012 by WHO have been missed and detection bias may contribute to these trends. In light of the new 2030 NTD roadmap and disease-specific targets, BU programmes are required to strengthen case detection and begin a transition towards integration with other skin-NTDs. This transition comes with new opportunities to enhance existing BU surveillance systems and develop novel approaches for implementation and evaluationIn this review, we present a breakdown and assessment of the methods and approaches that have been the pillars of BU surveillance systems in Africa i) Passive case detection ii) Data systems iii) Clinical training iv) Active case finding v) Burden estimation vi) Laboratory confirmation pathways. We discuss successes, challenges and relevant cases studies before highlighting opportunities for future development and evaluation including i) Novel data collection tools ii) Risk-based surveillance iii) Integrated skin-NTD surveillance. We draw on both experience and available literature to critically evaluate methods of BU surveillance in Africa and highlight new approaches to help achieve 2030 roadmap targets.