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Eur.J Ophthalmol
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Melanoma can spread to the subcutaneous tissue which lies underneath the skin, the lymph nodes, and to other organs such as the lungs, liver, bone or brain
A comprehensive initial evaluation should include: Complete medical history: Previous weight loss attempts, family history of obesity, current medications (many cause weight gain), surgical history, and psychiatric screening for eating disorders Physical examination: BMI calculation, waist circumference, blood pressure, assessment for acanthosis nigricans, thyroid palpation, and evaluation for Cushing syndrome signs Laboratory workup: Complete metabolic panel, lipid panel, HbA1c, fasting insulin, thyroid panel (TSH, free T3, free T4), vitamin D, testosterone (in appropriate patients), and liver function tests Body composition analysis: DEXA scan or advanced bioimpedance analysis to establish baseline lean mass, fat mass, visceral fat, and bone density Metabolic rate testing: Indirect calorimetry to measure resting metabolic rate, which informs caloric targets far more accurately than estimation equations Psychosocial assessment: Screening for depression, anxiety, binge eating disorder, emotional eating patterns, and readiness for change Risk Stratification and Treatment Planning Based on the initial assessment, patients should be stratified into treatment tiers that align intervention intensity with clinical need
During the dose-escalation phase of semaglutide (weeks 1 through 16 for the standard Wegovy titration), nausea affects roughly 44% of patients and vomiting roughly 25%
