Abstract : Granulomatous dermatoses are group of cutaneous lesions occurring as a type IV hypersensitivity reaction against poorly soluble reactive external or internal antigen which can have infectious or non-infectious etiology. They have overlapping features due to which the diagnoses prove to be a challenge for clinicians and pathologists. Hence, the accurate diagnosis is made from adequate clinical information combined with histopathology. The aim was to study the spectrum of granulomatous lesions of skin and to analyze the clinico-pathological correlation. A cross- sectional study of 2 years was conducted on 125 cases of skin biopsies histopathological diagnosed with leprosy. Adequate clinical history was obtained and biopsies were stained with hematoxylin and eosin along with special stains, wherever required. Total 538 skin biopsies were received out of which 125 were diagnosed as granulomatous lesions of skin. Maximum cases (31.20%) belonged to third decade of life with male to female ratio of 1.45:1. On histopathology, tuberculoid granuloma was the most common type. Majority cases were of infectious etiology with predominance of leprosy followed by tuberculosis. Overall leprosy and cutaneous TB showed a good clinic pathological agreement of 93.60% and 96.80%, respectively using Open Epi diagnostic test. Granulomatous skin lesions still pose a diagnostic challenge which raises the concern about therapeutic approaches and various health programmers. They may not have a classical clinical picture always. Hence, histopathological examination of the skin lesion along with proper clinical history and correlation of these findings help in arriving at an accurate diagnosis.