81.2 📚 國考版醫垫國考 / PGY OSCE

81.2.0.1 📌 Cram Sheet

81.2.0.1.1 🔥 高 yield 12
  1. 3 倧: BCC / SCC / Melanoma (+ Merkel)
  2. BCC: pearly + telangiectasia, metastasis < 0.1%, Mohs
  3. SCC: AK precursor, metastasis 2-5%, lip/ear high-risk
  4. Melanoma ABCDE + ugly duckling
  5. Breslow depth primary prognostic
  6. Acral lentiginous in Asians
  7. Sentinel LN for T1b (≥ 0.8 mm or ulceration)
  8. WLE margins: ≀1 mm→1cm; 1-2→1-2cm; >2→2cm
  9. BRAF V600E ~50% melanoma → dabrafenib+trametinib
  10. Pembro/nivo for advanced melanoma
  11. Ipilimumab + nivolumab combo
  12. Cemiplimab for SCC / vismodegib for BCC / avelumab for Merkel
81.2.0.1.2 🔢 必背
項目 æ•žå­—
BCC excision margin 4 mm
SCC excision margin 4 mm (low-risk)
Melanoma in situ margin 0.5-1 cm
Melanoma ≀ 1 mm 1 cm
Melanoma 1-2 mm 1-2 cm
Melanoma > 2 mm 2 cm
SLNB threshold T1b ≥ 0.8 mm or ulceration
BRAF mutation rate ~50%

81.2.0.2 ⭐ 高 yield

81.2.0.2.1 BCC vs SCC vs Melanoma
BCC SCC Melanoma
Frequency #1 #2 #3
Mortality 極䜎 äž­ 高
Metastasis < 0.1% 2-5% 高
Precursor — AK / Bowen Dysplastic nevus
Treatment Mohs / vismodegib Mohs / cemiplimab WLE + LN + immunotherapy
81.2.0.2.2 Melanoma Subtype 速蚘
名皱 特埵
Superficial spreading 最倚 (70%)
Nodular 快、垂盎
Lentigo maligna 老人、sun-damaged
Acral lentiginous 亞掲人倚 palms/soles/nails
Amelanotic 無色, 易挏蚺
81.2.0.2.3 Genetic Syndromes
  • CDKN2A: familial melanoma + pancreatic
  • BAP1: uveal melanoma + RCC + mesothelioma
  • MC1R: red hair, freckling, melanoma risk
  • Xeroderma pigmentosum: NER deficiency, multiple SCC/BCC/melanoma
  • Gorlin syndrome (PTCH1): multiple BCC, medulloblastoma, jaw cysts
  • Muir-Torre (Lynch variant): sebaceous neoplasm
81.2.0.2.4 Adjuvant Drugs (Stage III Melanoma)
  • Pembrolizumab
  • Nivolumab
  • Dabrafenib + trametinib (BRAF V600E)
81.2.0.2.5 Stage IV Drugs
  • Pembrolizumab / nivolumab
  • Ipilimumab + nivolumab combo (best response, more toxicity)
  • BRAF + MEK (V600E)
  • T-VEC (intralesional)
  • Tebentafusp (uveal — HLA-A*0201)

81.2.0.3 🎯 自我檢枬

  1. ABCDE? → Asymmetry, Border, Color, Diameter > 6 mm, Evolving
  2. Acral 倚芋族矀? → 亞掲人
  3. Breslow depth threshold for SLNB? → 0.8 mm or ulceration
  4. WLE margin for 1.5 mm depth? → 1-2 cm
  5. BRAF V600E mutation rate? → ~50%
  6. BRAF + MEK drugs? → Dabrafenib + trametinib
  7. Vismodegib target? → Hedgehog SMO (BCC)
  8. Cemiplimab indication? → Advanced SCC (and BCC 2nd line)
  9. Avelumab indication? → Merkel
  10. Gorlin syndrome gene? → PTCH1 (multiple BCC)
  11. CDKN2A syndrome? → Familial melanoma + pancreatic
  12. Bowen disease? → SCC in situ

⚠ AI 草皿。