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Abstract Macrocheilia, as an initial manifestation of leprosy, is uncommon. We present a case of a 50‐year‐old female, with lower lip swelling, initially diagnosed as Cheilitis Granulomatosa Miescher. Unresponsiveness to local intralesional corticosteroids necessitated further evaluation. Repeat tissue sampling yielded a confirmatory diagnosis of borderline tuberculoid leprosy, which was managed successfully.