Background: Hyperpigmented skin lesions are a common dermatologic concern, necessitating accurate diagnosis for appropriate treatment. While clinical diagnosis is often challenging due to overlapping features, histopathological evaluation serves as a crucial tool for definitive diagnosis. This study aimed to assess the spectrum of hyperpigmented skin lesions, their demographic distribution, and the correlation between clinical and histopathological diagnoses.Materials and Methods: A prospective descriptive study was conducted in the Department of Pathology at Rajarajeswari Medical College and Hospital (RRMCH), Bengaluru, over two years (June 2015 – May 2017). A total of 100 skin biopsies from clinically diagnosed hyperpigmented lesions were included. The samples were fixed in 10% formalin, processed, and stained with hematoxylin and eosin. Histopathological findings were documented and compared with clinical diagnoses. Results: Among the 100 cases, 76% were non-neoplastic and 24% were neoplastic lesions. Lichen planus and its variants were the most common non-neoplastic lesions (51.31%), with classical lichen planus accounting for 28.94%. Neoplastic lesions comprised 15 melanocytic (62.5%) and 9 non-melanocytic (37.5%) cases. Benign melanocytic nevi (54.1%) were the predominant neoplastic lesion, followed by seborrheic keratosis (33.33%). The lesions were more frequent in females (54%) than males (46%), with a female-to-male ratio of 1.17:1. The third decade (21-30 years, 23%) had the highest incidence. Extremities were the most affected site (63.15% of non-neoplastic and 33.33% of neoplastic lesions). Clinical and histopathological concordance was 94%, while discordance was 6%.Conclusion: Histopathological examination is essential for accurate diagnosis of hyperpigmented skin lesions, as clinical diagnosis alone may be insufficient due to overlapping features. Classical lichen planus was the most common non-neoplastic lesion, while benign melanocytic nevi were the predominant neoplastic lesion. The high clinicopathological concordance (94%) underscores the importance of histopathology in confirming clinical suspicions and guiding appropriate management.