Introduction and Aim: Nuchal-type fibroma (NTF) is a rare benign fibrous proliferation primarily originating from the dorsocervical neck region. Enzinger and Weiss first characterized it in 1988, highlighting its distinct histopathological features. Description of the Case Report: We present a case of 71-year-old South Asian male patient with painless swelling over the nape of neck, highlighting the challenges in diagnosis of NTF. Clinical examination, imaging, and cytological findings initially suggested a lipomatous lesion. Histopathological evaluation revealed characteristic features consistent with NTF, emphasizing the importance of histopathological assessment for accurate diagnosis. Despite its benign nature, vigilance is essential due to the potential for recurrence. Conclusion: This case underscores the need for a comprehensive understanding of NTF's clinical and histopathological features to facilitate optimal management and improve patient outcomes.