Superficial soft tissue swellings include a wide spectrum from benign to malignant lesions. High-resolution ultrasonography (HRUS), especially with grayscale, Doppler, and strain elastography (multiparametric approach), improves diagnostic accuracy due to its availability, real-time imaging, and cost-effectiveness. Objective: To assess the diagnostic accuracy of multiparametric HRUS in differentiating benign and malignant superficial soft tissue swellings using histopathology as the reference standard. Materials and Methods: This prospective study included 32 patients with superficial soft tissue swellings over six months (July 2025-January 2026). All lesions were evaluated using grayscale, Doppler, and strain elastography, and findings were correlated with histopathology. Results: Of 32 lesions, 18 were malignant and 14 benign on HRUS. Histopathological correlation showed concordance in 30 cases, yielding an accuracy of 94%, with two false-positive cases. Conclusion: Multiparametric HRUS is a reliable, non-invasive tool for differentiating superficial soft tissue swellings, with lesion morphology, vascularity, and stiffness significantly improving diagnostic accuracy.