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Apremilast for a psoriasis patient with HIV and hepatitis C

densely packed, small round blue cells (Fig. 2b), arranged in irregular nests, immunoreactive with chromogranin and Keratin 20, thus consistent with MCC. Red nodules do represent diagnostic challenges for two reasons: first, they do not display specific clinical dermoscopic criteria that allow to correctly classify a given tumour; second, nodular tumours, especially high-grade tumours (i.e. melanoma and MCC), have a fast growing attitude and thus, a prompt excision could result in better prognosis. RCM is a relatively new device that is nowadays available in tertiary referral centres in Europe and in other countries. The great opportunity to observe cellular details in vivo makes RCM useful tools for tumour diagnosis. In the present case, we reported for the first time the typical RCM findings seen in MCC. Small hyoporefrective cells arranged to form solid aggregates are seen in the context of fibrotic stroma and prominent vasculature. Although those findings could be observed in some melanoma subtype (i.e. nevoid), the monomorphous appearance favoured the diagnosis of a non-melanoma skin cancer, not basal cell carcinoma. Interestingly, RCM findings mirrored perfectly the histopathologic aspects of MCC as displayed in Fig. 2. Although our description is based on one single case report, RCM could be of help in the differential diagnosis of red nodules and in the identification of MCC. Further multicentric studies on this rare tumour are warranted to further explore RCM-specific morphology and the value of MCC confocal features in clinical practice.