We report a case of benign fibrous histiocytoma (BFH) of the medial canthus that mimicked keratoacanthoma in clinical appearance and growth. Excisional biopsy confirmed the diagnosis of the cellular subtype of benign fibrous histiocytoma. These types of BFH are typically more aggressive in growth, with a high recurrence rate and a tendency to undergo autonomous growth at other sites. The diagnosis of BFH should also be considered among those that appear typical of keratoacanthoma. Similar to other rapidly enlarging eyelid tumors, prompt excisional biopsy is recommended.