Background: Leprosy is one of the oldest and chronic infectious diseases known to human being caused by Mycobacterium leprae. Leprosy is widely prevalent in all parts of India and it presents with different clinico-pathological forms. However a great variation is seen in interpretation of clinical and histopathological examination of these lesions. The present research was taken to study the correlations between the clinical and histological diagnosis and to evaluate the importance of skin biopsy as an important diagnostic and spectrum defining tool. Methods: A prospective hospital based study was conducted among patients attending Dermatology OPD of two tertiary care centres in this region over a period of two years. All clinically suspected new leprosy patients were included in the study. A detailed clinical history and examination was carried out and skin biopsies were taken from the most active part of lesions. Sections were stained with Hematoxylin & Eosin stain and Fite-Feracco stain. Histopathological findings were compared with clinical diagnoses. Results: A total of 190 cases were studied, out of which 137(72.10%) were males and 53(27.9%) were females. The histopathological diagnosis of leprosy was established in 99.47% of clinically diagnosed cases. Clinico-histopathological concordance was seen maximum in LL (97.22%), followed by BT (79.76%), TT (71.43%), BL (66.67%), BB (66.67%) and least in IL (50.00%). Overall concordance was 56.54% Conclusion: Clinical diagnoses of Leprosy still pose a significant problem, especially the Intermediate subtypes of the disease spectrum. Histopathological examination of the active skin lesions should be done in all new cases to confirm the spectrum of disease and expected duration of therapy.