Esophageal epidermoid metaplasia is a rare premalignant condition characterized histologically by a well-developed granular layer with hyperorthokeratosis and is associated with an increased risk of esophageal squamous cell carcinoma. We present a case of a 56-year-old woman with progressive dysphagia and weight loss who was diagnosed with epidermoid metaplasia that demonstrated histologic resolution during surveillance, despite persistent endoscopic abnormalities. This case highlights the uncertainty surrounding disease progression and emphasizes the need for ongoing endoscopic surveillance even in the setting of apparent histologic regression.