Cameo of Futility is obtained by killing the Darkness Spite found in the first level of Rahkon.
The Cameo normally drops when he is killed. The Cameo is considered to be a Healer or Mage class item. Since the Cameo of Futility is a blue named item, it cannot be traded in-game. It can only be traded through the exchange market. It is highly recommended any party's killing the Darkness Spite to set the party's distribution to "Free" and have any healers or mages obtain the item.