The International Consensus Classification (ICC) of myeloid and lymphoid neoplasms follows the precedent set in the Revised European-American lymphoma classification for modern lymphoma classifications by defining specific diseases on the basis of all the available morphologic, immunophenotypic, genetic, and clinical findings. Primary cutaneous lymphomas exhibit a broad range of clinical behavior ranging from lesions which spontaneously regress to those which run an aggressive, often fatal course. Accurate separation of entities is therefore essential for prognostication and to ensure appropriate treatment is administered. However, despite marked differences in clinical course, many subtypes of primary cutaneous lymphoma exhibit remarkably similar, often overlapping, and sometimes indistinguishable pathologic features. While molecular analysis has furthered our understanding of some of these disease entities, it does not yet facilitate robust distinction. Thus, clinical correlation retains a central role in both the diagnosis and classification of primary cutaneous lymphoma. This review aims to draw attention to problem areas in differential diagnosis and hopefully offer some practical suggestions for resolving difficult cases. It will also highlight recent advances in the field and discuss how they reinforce the current classification system and how they might impact of future classifications and treatment strategies.