The foreskin is a common surgical specimen encountered by the practising histopathologist. Therapeutic circumcisions are performed to treat both benign and neoplastic foreskin lesions. Penile intraepithelial neoplasia (PeIN) is the precursor lesion of penile squamous cell carcinoma (SCC). The World Health Organisation (WHO) classifies PeIN into two subtypes based on the association with Human Papillomavirus (HPV); these include differentiated and undifferentiated PeIN. These subtypes of PeIN can be differentiated by specific cytological and architectural characteristics. This review article will discuss these histological characteristics and highlight potential difficulties that may arise in diagnosing PeIN. Furthermore, it will also consider common benign and preneoplastic foreskin lesions that may be encountered when reporting the foreskin specimen.