Recent research in the southern Central Balkans has resulted in the discovery of the first Middle Paleolithic sites in this region. Systematic excavations of Velika and Mala Balanica, and Pešturina (southern Serbia) revealed assemblages of Middle Paleolithic artifacts associated with hominin fossils and animal bones. This paper focuses on Pešturina Layer 4, radiometrically and biostratigraphically dated to Marine Isotope Stage (MIS) 5, which yielded traces of temporary hunting camps. The remains of large ungulate prey are associated with predominantly Quina-type artifacts made of quartz. Artifacts from Pešturina Cave have no parallels at Mousterian sites in the Balkans but are rather similar to the Central European Charentian, which demonstrates that this cultural unit was widespread during MIS 5, not only in the southern Pannonian Basin but also in the Central Balkans. The position of the site – on the outskirts of the known spread of the Quina model of techno-economic behavior during MIS 5 – raises several questions related to population movements, residential mobility, and technological variability in the early Middle Paleolithic of Central and Southeast Europe.