Background: In the context of Iraqi communities, mycosis fungoides (MF) is the main cutaneous T-cell lymphoma that is the most prevalent, but little information is available about it. One of the areas that is still being actively researched is the role that tumor-associated macrophages (TAMs), which are identified by their expression of CD68, play in the course of illness. Objective: is to define the demographic, clinical, and immunohistochemical characteristics of MF in an Iraqi cohort, with a particular focus on identifying relationships that may provide evidence regarding the pathogenesis and course of the illness. Methods: A retrospective review of 22 patients diagnosed with MF at a single dermatology center in Iraq (2020–2025). Data on age, sex, disease duration, clinical subtype, stage, and CD4/CD8/CD68 expression were analyzed using Mann-Whitney U tests, Kruskal-Wallis tests, Fisher's exact tests, and Spearman's correlation. Results: A retrospective review of 22 individuals diagnosed with MF at a single dermatological center in Iraq (2020–2025) was conducted as part of the methodology involved. Mann-Whitney U tests, Kruskal-Wallis tests, Fisher's exact tests, and Spearman's correlation were utilized in order to assess the data pertaining to age, gender, length of disease, clinical subtype, stage, and expression of CD4/CD8/CD68 and other related factors. As a result, the cohort consisted of 14 males and 8 females, with a gender ratio of 1.75:1. In this study, it was discovered that males presented at a considerably older age compared to females (49.2 ± 13.7 years versus 35.5 ± 13.1 years, p = 0.023). This is a novel discovery that has not been discussed in the literature before. There was a positive correlation between the length of the disease and the age at diagnosis (ρ = pokilodermatous -erythrodermic, p = 0.028), which indicates that older patients may have delayed presentation. In addition to lichenoid (18.2%) The least was a female patient 15 years old who had hypopigmented MF. There were two significant associations that were found associated with CD68 expression: Strong CD68 positivity was significantly associated with tumor-stage disease (present in 2/2 tumor-stage patients compared to 3/17 patch/plaque patients; p = 0.048); and patients with strong CD68 expression had significantly longer disease duration than those with weak or negative expression (7.8 ± 3.1 years versus 4.2 ± 3.1 years, p = 0.035). The CD4+ phenotype was the most prevalent (84.2%). Conclusion: This work reveals unexpected findings in an Iraqi MF cohort, including a large age discrepancy between the sexes at the time of diagnosis, a link between age and the length of the disease, and, most importantly, dual associations of CD68 expression with both advanced stage and prolonged disease duration. These findings imply that tumor-associated macrophages have a role in the chronicity and progression of mycosis fungoides (MF), raising the possibility that CD68 could be used as a biomarker for risk classification. It is necessary to do more extensive research in order to verify these discoveries and investigate the consequences they have for prognosis.