Maculopapular cutaneous mastocytosis (MPCM) is a variant of cutaneous mastocytosis resulting from abnormal accumulation of mast cells in dermal tissues. Ultrasonography is a contemporary, safe, non-invasive, and real-time diagnostic method. High-frequency ultrasonography (HFUS) utilizes probes emitting frequencies of 20 MHz and higher, visualizing and measuring areas of healthy and lesional skin in various dermatologic conditions. We examined 4 patients with MPCM using a taberna pro medicumTM (Germany) device. We present 2 characteristic ultrasonographic patterns of MPCM lesions. Three subjects presented with an abnormal, widened, and hypoechogenic area representing the dermis. One subject demonstrated an anechogenic fusiform structure below the epidermis that represented a localized pattern of infiltrate. This patient responded better to psoralen and ultraviolet A radiation (PUVA) therapy than the other subjects. Our research implies that HFUS may be used as an additional method in evaluating skin lesions in MPCM.