Objectives: The histopathological diagnosis of Mycosis Fungoides(MF) is challenging in its early stages and can easily be confusedwith inflammatory dermatoses. This study aims to; (i) assessthe frequency and significance of different histopathologicalparameters in early MF, seen in Saudi patients, and (ii) to studythe utility of these parameters in differentiating between early MFand inflammatory dermatoses.Methods: This is a five years study of 66 skin biopsies generatedfrom 58 patients with clinically suspicious MF lesions or earlypatch stage MF. These cases were retrieved from the archives ofthe Department of Pathology, King Khalid University Hospital,Riyadh from the year 2002 to 2006. Histological criteria wereassessed and graded semi-quantitatively on a four-point scale by adermatopathologist and two pathologists independently.Results: The histological parameters suggesting the diagnosisin early stages MF include epidermotropism, dermal fibrosis,Pautrier’s micro abscesses, Basal alignment of neoplasticlymphocytes, hyperconvoluted dermal and epidermal lymphocytesand grandiosity sign (size of lymphocytes becoming largeras they migrate towards granular layer of epidermis). Theseparameters on univariate analysis achieved statistical significance(p<0.05) in differentiating MF from non-MF cases. In addition,hyperconvoluted dermal and epidermal lymphocytes proved to behighly reliable with high specificity and sensitivity.Conclusion: The histopathological diagnosis of early MF lesionsand their discrimination from inflammatory simulators can beachieved by carefully observing the hyperconvoluted dermal andepidermal lymphocytes along with the constellation of the otherparameters.