After 6 cycles of chemotherapy, taking into account the different response of visceral masses and skin lesions, a biopsy of a skin nodule was performed: it confirmed that subcutaneous nodules were metastases from the primary small cell neuroendocrine carcinoma with positivity for Synaptophysin and CD56 and negativity for Chromogranin A and CK20. The gene discussed is SYP; the disease is small cell carcinoma.