A benign masquerade of eyelid malignancy: Discoid lupus erythematosus

A 50-year-old female presented with redness and itching over her right lower eyelid for 6 months. She had a diffusely hyperpigmented lesion with a purplish hue over her right lower eyelid. There was diffuse loss of eyelashes and obliteration of meibomian gland openings along the lesion. The ocular examination was otherwise unremarkable. In view of the clinical features, the possibility of squamous cell carcinoma was considered, and an incisional biopsy was performed. Histopathology was suggestive of discoid lupus erythematosus. The patient was treated with oral hydroxychloroquine sulfate for 6 months. The lesion regressed, and no new lesions developed over a 2-year follow-up. This report showcases how a benign lesion can rarely present with clinical features classically associated with a malignant pathology and highlights the importance of histopathological evaluation for proper diagnosis.