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cell carcinoma? Merkel cell carcinoma (MCC) is a rare neuroendocrine carcinoma of skin with high rate of recurrence, metastasis, and mortality. It usually presents with an asymptomatic, rapidly growing, pink-to-violaceous plaque or nodule on the head and neck region. Old age, sun exposure, immunosuppression, and polyomavirus are factors that may play a role in the pathogenesis. Dermoscopy is a noninvasive, accessible method that helps in differentiation between benign and malignant skin lesions. An 82-year-old man was referred to our center, Razi Hospital, Tehran, Iran, with an asymptomatic pink nodule on the vertex that had been present for 4 months (Fig. 1). Digital dermoscopic examination with FotoFinder HD 1000 showed linear irregular vessels, polymorphous vascular structure (large, enlarged branching, linear beaded, horseshoe like, arborizing, and linear or curved narrow vessels), milky pink areas, pinpoint red dots, white structureless areas, fine and thick white scale, and hyperkeratotic yellow and hemorrhagic crust (Fig. 2). Histopathologic examination showed a diffuse and infiltrative small, round cell tumor extending from the undersurface of ulcerated epidermis to deep dermis (Fig. 3a,b). Vascular proliferation was present in mid to deep dermis. Immunohistochemistry staining revealed characteristic perinuclear dot-like immunoreaction of cytokeratin 20 (CK20) and cytokeratin AE1/AE3, epithelial membrane antigen (EMA) showed a weakly positive membranous reaction (Fig. 3c,d), and P63 showed a diffuse nuclear immunoreaction. Ki-67 proliferative marker counts were about 35% (Fig. 3e,f). These findings were consistent with MCC. Jalilian et al. reported dermoscopic features of 12 cases. All of them had polymorphous and linear irregular vessels, poorly focused vessels, and structureless areas. In the study of 10 patients by Dalle, et al., frequent dermoscopic findings included milky red color usually associated with vascular patterns. All 10 cases by Harting et al. demonstrated milky red areas or globules and numerous linear irregular vessels. Blue-gray veil and pigmented structure were not reported in any of these studies. Other dermoscopic features that have been reported in the literature are reviewed in Table 1. The most common dermoscopic finding is milky red areas that are usually associated with linear irregular vessels, red dots, polymorphous vascular pattern, and architectural disorder. While these patterns can be seen in amelanotic melanoma, lack of findings such as pigmentation and blue-gray veil is against this diagnosis. White structureless areas are reported as shiny or nonshiny streaks and globules frequently in MCC. Arborizing vessels consist of a large stem vessel with fine branches. In basal cell carcinoma, they are well defined and have distinct red color which indicates superficial location of vessels, in contrast to poorly focused and pink colored vessels seen in MCC, which shows that vessels lie deeper. Milky red areas alone can be seen in benign lesions such as pyogenic granoluma, but absence of collaret may help in differentiation. Linear irregular vessels can be found in adnexal tumors and metastatic lesions too. Angiogenesis is an important factor in tumor clinical behavior as well as dermoscopic features. The amount of vascularity has direct association with the prognosis. Histopathologic findings suggest that deep angiogenesis is associated with milky red areas. Linear irregular vessels can be found in areas of dilated vessel aggregations. Glomerular vessel is a common dermoscopic feature in Bowen’s disease. Scale and hyperkeratosis can be found in Bowen’s disease and squamous cell carcinoma (SCC). The presence of these two findings in MCC can be associated with epidermotropism and were found in a case of combined MCC/ SCC. In conclusion, although there are not specific dermoscopic features for MCC, milky red areas along with polymorphous, linear irregular and arborizing vessels are usual findings with presence of them indicating the possibility of malignancy and the need for prompt evaluation.