Primary Cutaneous Follicle Center Lymphoma (PCFCL) is a rare subtype of Non-Hodgkin Lymphoma that primarily affects the skin without systemic involvement. It often mimic other dermatologic conditions, leading to diagnostic challenges. We report the case of a 54-year-old male who presented with multiple facial lumps persisting for 1.5 years, progressively increasing in size and number, particularly on the cheeks. The lesions were pruritic and worsened with sweating and fish consumption, but there was no associated pain or numbness. Initial evaluation excluded leprosy based on the absence of clinical signs and negative acid-fast bacilli on skin slit smear. Treatment with topical corticosteroids and antihistamines was ineffective. Histopathological examination initially suggested granuloma faciale; however, immunohistochemistry confirmed the diagnosis of PCFCL, demonstrating positivity for CD20, Ki67 (50%), CD21, CD10, CD23, and BCL-6, and negativity for BCL-2 and CD5. The patient was referred for chemotherapy and completed four of six planned cycles but discontinued treatment due to adverse effects. Notably, clinical improvement was observed after three sessions, and no signs of relapse were detected after six months after therapy discontinuation. This case underscores the importance of considering PCFCL in the differential diagnosis of persistent facial lesions and highlights the critical role of histopathological and immunohistochemical analyses in establishing an accurate diagnosis. Early recognition and a multidisciplinary approach involving dermatologists, pathologists, and oncologists are essential for effective management. Patient adherence and close follow-up also significantly contribute to favorable long-term outcomes in PCFCL.