Superficial basal cell carcinoma masquerading as pruritic dermatitis on the upper eyelid

Although basal cell carcinoma is the most common form of skin cancer, the superficial subtype is rarely seen on the upper eyelid. We report the case of a 71-year-old woman with a 4-year history of upper eyelid pruritus, initially diagnosed as blepharitis and unsuccessfully treated with various medications, including topical and systemic corticosteroids, topical immunomodulators, and antihistamines. The unusual presentation, location, histologic subtype, and persistent pruritus posed a significant diagnostic challenge in this case.