Physician (MD, DO)
Dermatology
Specialty
Cosmetic Dermatology, Pediatric Dermatology
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Pima Dermatology
5150 E Glenn Street
Tucson, Arizona 85712 [MAP]
For an appointment, call (520) 795-7729
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Medical Expertise

Dr. Goldberg specializes in medical, pediatric and surgical dermatology and has particular expertise in the use of lasers for the treatment of skin conditions and for aesthetic medicine.

acne,

Tips & Wisdom

Tattoo Removal Options
Tattoos no longer should be viewed as permanent. Several very good options now exist for removal of tattoos. There is simply not one method that is right for every person, nor for every tattoo. The ability to remove a tattoo will vary by the amount, color, age, and depth of tattoo pigment applied to the skin. In general, the older the tattoo, the faster it responds to treatment. Certain colors and complex pigments such as greens, purples, and yellows, may be more difficult to remove. Different techniques may be needed to remove different colors from the skin. No two tattoos are the same and there is often quite a difference in how fast any given tattoo will respond to a given therapy. Generally, it takes 4-8 treatments or more to remove the tattoo.
Spider Vein Treatment

Spider veins on the legs appear as branch like red or blue vessels. They are much more common in women, particularly after pregnancy and can be painful when enlarged. If left untreated, veins can become larger and varicose and are associated with swelling and ulcerations.

The most common technique for spider vein treatment is injection sclerotherapy. This is a micro-injection technique consisting of instilling one of several solutions into these small capillaries. The most common solution is.1-1% Sotradecol. The concentration and quantity of solution used depends on the size and length of the vessel treated.  Sotradecol irritates the inner lining of the vessels so the vessels cease to carry blood and the body slowly replaces them with scar tissue without harming the circulation.

Laser treatments of spider veins are also available as a backup or secondary treatment for vessels too small to treat or do not respond to sclerotherapy. We utilize four different Laser devices including:

  • Versapulse
  • Vbeam
  • Gentle:YAG
  • Sciton

Post Treatment

Strenuous physical activity or prolonged periods of standing should be avoided for the first 24 hours after spider vein treatment. Support hose should be worn for 2-3 weeks. Normal light activity or exercise is suggested.

Frequently Asked Questions

How soon will the vessels disappear?

Each vessel may require 2-3 injections. The vessels disappear over a period of 2 weeks to 2 months. Recurrences can occur over a period of 1-5 years. This treatment does not prevent new vessels from occurring.

What are the side effects? (Most patients have little side effect)

  • Slight discoloration may occur as the vessels are resolving. This discoloration can last for several weeks to several months.
  • Bruising can happen when vessels are very weak and can last from 2 weeks to 2 months.
  • A Clot could develop at the injection site, but will never cause internal problems.
  • Swelling is particularly common when patients have jobs in which they stand for long periods of time, or in which vessels in the ankle or lower portions of the legs are involved.

Is this method superior to Laser? 

This procedure is less painful then with Lasers. The Laser is a more expensive treatment and is usually reserved for vessels which do not respond to injection therapy.

Basal Cell Carcinoma at Pima Dermatology

Causes

Chronic exposure to the sun is the cause of almost all BCCs, which most  commonly occur on exposed parts of the body (the face, ears, neck, scalp, shoulders, and back).

Condition Overview

Basal Cell Carcinoma is the most common form of skin cancer, affecting one million Americans each year. BCC is the most common of all cancers. Anyone with a history of sun exposure can develop BCC. Basal Cell Carcinoma arises in basal cells, which are at the base of the epidermis.

Treatment

The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient’s age and general health. 

  • Curettage and Electrodessication: the growth is peeled away with a curette and the heat produced by an electrocautery needle destroys the residual tumor and controls bleeding. This treatment works well for small and superficial lesions.
  • Excisional Surgery: the growth is cut out and then closed with stitches.
  • Mohs Micrographic Surgery: Microscopically controlled excisions. This technique minimizes removal of normal skin and is reserved for large recurrent or difficult to treat areas of the skin.
  • Immune System Stimulators (Aldara): These agents are applied 3-5 times weekly, for 4-6 weeks to remove unwanted irregular cells.

Warning sign of a Basal Cell Carcinoma, a type of skin cancer, include the following

  • An Open Sore that bleeds, oozes, or crusts and remains open for a few weeks only to heal up and then bleed again. A persistent, non-healing sore is a very common sign of an early BCC.
  • A Reddish Patch or irritated area, frequently occurring on the face, chest, shoulders, arms, or legs. Sometimes the patch crusts and it may also itch. At other times, the patch persists with no noticeable discomfort.
  • A Pink Growth with a slightly elevated rolled border and crusted indentation in the center. As the growth slowly enlarges, tiny blood vessels may develop on the surface.
  • A Shiny Bump or nodule that is pearly or translucent and is often pink, red or white. The bump can also be tan, black or brown, especially in dark-haired people and can be confused with a mole.
  • A Scar-Like Area that is white, yellow or waxy, that often has poorly defined borders; the skin itself appears skinny and taut. This warning sign can indicate the presence of small roots which make the tumor larger than it appears on the surface.
Laser Treatment of Hemangiomas at Pima Dermatology

Also known as: Strawberry Birthmarks, Hemangioma 

Causes: Unknown

Condition Overview

Present in up to 10% of newborns; may become apparent in the first days and weeks of life, expands in the first year, and regress by year 2 - 5 of age. The most serious lesions exist on the face and affect function if they occur around the eyes, mouth, nose and throat.

Symptoms

Expanding red/purple lesion which may break down and bleed, become ulcerated, or get infected.

Treatments

It is very important that a baby with a vascular birthmark is examined as early as possible so that a correct diagnosis is made and treatment discussed 

  • Corticosteroid medication can either be injected into the Hemangioma or given by mouth. Treatments may be necessary for weeks or months to suppress rapid growth in the first months of life. 
  • Laser Treatment with pulsed dye laser, either before rapid growth or if residual vessels are present, after the birthmark shrinks.
  • Surgical revision of localized lesion or the scar and redundant skin, after the lesion is fully regressed.
Stretch Marks

While there are no perfect stretch mark treatments, there are a number of good option available to improve the appearance stretch marks.

Home applied products such as glycol creams and retinoids can help to stimulate new collagen formation and repair of the damaged skin in the stretch mark.

Various laser and light sources have been utilized to stimulate collagen remodeling, decrease the redness and visibility of the stretch mark. Various combinations of laser, such as the Vbeam Pulsed Dye Laser, Gentle: YAG Lasers are particularly helpful with younger redder stretch marks, some mature white stretch marks can be improved using infrared Lasers (such as Gentle:YAG or Smoothbeam) or the Fractional resurfacing devices (Palomar Starlux).

Treatment of Brown Spots
  • Home Treatments for Brown Spots. Home Treatments can be designed for your skin type and complexion, and usually combine the use of a lightening cream (Obagi Clear) and a broad spectrum sunscreen. A topical retinoid, such as Renova, Retin-A, Differin or Tazorac, may also recommended.
  • Office Treatments for Brown Spots. A series of light acid peels can be applied successfully in our Aesthetics Department. The strength and type of acid applied depends on your skin type and the depth of skin discoloration. These procedures are usually performed in a series of 3-6 peels at 2-4 week intervals. A light acid peel usually causes some mild redness but virtually no disruption in your activities. On occasion, a stronger acid peeling agent (TCA) will be applied to more stubborn lesions. TCA is an acid that is utilized at various strengths by your doctor. A crust or scab usually is present for a number of days following this treatment.
  • Liquid nitrogen. Liquid nitrogen therapy is also an effective treatment for smaller, and fewer brown spots. Treatments are performed safely and comfortably often in one treatment session in our office. A crust or scab will usually develop at the site for a few days and which will go away within a week or less.
  • Laser Treatment Options. Lasers work by being selectively absorbed by the abnormal brown pigment, often sparing other non-affected skin structures. The current Laser options in our office include the Versapulse Laser and the Vbeam Laser. These devices precisely target the brown pigment and leave an immediate, small brown or gray surface change, which subsequently scabs and falls off over a period of several days to a week. These Lasers are the most effective devices, usually yielding excellent results in 1-2 sessions.
  • Intense Pulsed Light. Starlux Intense Pulsed Light system is used for improvement of brown and red spots. There is often some brown scaling or scabbing that occurs for several days to a week following these treatments. Typically the treatments are less costly and more gentle than the Lasers, but may require up to 2-5 treatments to get the best results.
Ways to Rejuvenate Your Facial Skin

Facial rejuvenation provides a more youthful appearance to skin that has been impacted by aging and sun exposure. It combines a variety of dermatologic procedures to provide a rejuvenated and healthy look. Reduce wrinkles, remove age spots, tighten loose skin and provide a more youthful appearance with better skin texture, tone and color.

OPTIONS

1) Medications and Skin Care Products (Applied to the Skin)

  • Prescription-only medications, such as topical retinoids (Renova, tretinoin) are effective for treating fine lines and superficial wrinkles. The use of retinoids may also increase the the time between treatments.
  • Over the counter (OTC) products such as cosmeceuticals with glycolic acids, antioxidants and peptides.

2)  Dermal Fillers (Juvederm, Radiesse, Restylane)- Dermal fillers “plump” up the lines and furrow in the face, which smoothens the skin and reduces the appearance of wrinkles.

3)  Botulinum Toxin (Botox, Dysport)- Botulinum toxin injections diminish lines and wrinkles associated with facial expression. Botulinum toxin (Botox, Dysport) is used to treat vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and wrinkles around the eyes (“crow’s feet”). It may also be used to diminish the appearance of bands on the neck.

4) Dermabrasion and Microdermabrasion -  Rub away the topmost layer of skin (epidermis) to provide a rejuvenated appearance.

5) Chemical Peels- Chemical peels use a chemical solution to remove the outer layers of skin and stimulate new skin growth.

6) Laser & Light Therapy

  • Non-Ablative Laser Rejuvenation- Laser rejuvenation with “non-ablative” lasers can work on the deep layers of the skin to stimulate collagen growth and tighten underlying skin to remove fine lines and wrinkles. There is also minimal downtime.
  • Laser Resurfacing- Laser resurfacing with “ablative” lasers accurately removes the topmost layer of skin for the treatment of wrinkles, and deeper scars. Ablative lasers can also induce skin tightening and improve texture and tone. The CO2 laser and erbium:YAG laser are the ‘traditional’ lasers used for laser resurfacing.
  • Fractional Lasers- Fractional lasers offer a new developmentin laser technology. They split (“fractionate”) the laser beam into millions of tiny dots. When the fractional laser is applied to the skin, each dot treats just a microscopic section of skin and is surrounded by untreated skin. The skin in the treated area develops new collagen for up to one year, leading to a fuller, more youthful appearance. The skin heals quickly with few complications because the surrounding untreated tissue supports the treated skin.
  • Intense pulsed light (IPL) (Photofacial)- Intense pulsed light (IPL) is a non-invasive treatment that uses high intensity pulses of visible light to treat a variety of skin conditions, including facial lines and wrinkles. IPL may be referred to as a “photofacial” or “photorejuvenation”.
  • Tissue Tightening (Thermage, Titan)- Radiofrequency waves can be targeted to the deepest layers of the skin, resulting in skin contraction and tightening. This non-invasive approach can lead to gentle lifting of the face, brow, and cheeks without downtime. Thermage is the most commonly known tissue tightening device, but there are several others now available.
  • Photodynamic Therapy (PDT)- Photodynamic therapy involves the application of a medicine to the skin that is left in place for a specified time. This helps to sensitize the skin to light. The area is then treated with blue light, IPL, or a laser. The procedure can provide a rejuvenated appearance and effectively treat early changes in the skin that may lead to skin cancer.

7) Surgical Excision - Some skin lesions, such as moles, scars, and benign skin growths, may be surgically removed (excised)

Which Treatments are Best for Me?

Your doctor will recommend a treatment best suited to your personal needs, desires, medical history and skin type. In most cases, multiple procedures will be combined for the best possible outcome and long-lasting results.

In general, more mild treatments are recommended for those with minimal signs of aging or sun damage, and more aggressive treatments may be recommended for those with more advanced signs of aging or sun-damaged skin. For instance, those with minimal signs of aging may achieve wonderful results with the use of only topical retinoids, microdermabrasion, superficial chemical peels, and/or Botox.

Those with moderate signs of aging may benefit from the addition of dermal fillers, medium-depth peels and/or IPL (photofacial).

Those with more significant signs of aging may benefit from the addition of ablative laser resurfacing and/or deep chemical peels.

Actinic Keratoses (AKs) at Pima Dermatology

Causes

Chronic sun exposure. Sun exposure is cumulative, so even a short period in the sun adds up over a lifetime.

Condition

Actinic Keratosis is a scaly or crusty growth or lesion most often found on a bald scalp, face, ears, lips, hands or any other sun exposed area of the body. AKs develop slowly and range in size from a 1/8 of an inch to a 1/4 of an inch. Most AKs become red but some will be light or dark tan, pink, or the color of your skin. 

How to Recognize AK

Elevated, rough in texture and resemble warts

Fine sandpapery roughness or scaly, crusty surface

Treatments

  • Topical Medications: Aldera, 5-Fluorouracil (5-FU), Imiquimod
  • Cryotherapy or Liquid Nitrogen Therapy: Freezes the AKs. Repeat treatment may be necessary.
  • Laser Surgery
  • Photodynamic Therapy: Topical 5-aminolevulinic acid (5-ALA), is applied to lesions and exposed to strong light which activates the 5-ALA and destroys the actinic keratosis
Botulinum Toxin for Cosmetic Uses at Pima Dermatology

Treats: Wrinkles, Crows Feet, Vertical Lip Lines, Smokers Lines, Wrinkle correction, Frown Lines

Conditions Treated

Wrinkles due to muscle movement in the forehead (frown lines) and the eyes (crow’s feet), and around the mouth (vertical lip lines) are treatable.

Treatment Overview

Botox® Cosmetic is quick and easy with minimal discomfort. A few tiny injections are made into the muscle group being treated. No anesthesia is required, though there is the option to numb the skin prior to injection. 

Common side effects

The most common side effects following the injection of Botox® Cosmetic is bruising. Rarely, a headache, flu-like symptoms, a temporary eyelid droop, or nausea may occur.

Recovery

Results are expected to appear within days after your treatment, with continuing improvement at the injection site for about a week. Normal activity may be resumed immediately after the treatment. Using the muscles after the treatment will help Botox® work better. For example: frown, smile or raise your eyebrows often following treatment.

Chemical Peels Overview at Pima Dermatology

Treats: Wrinkles, Wrinkle correction, Age Spots, Brown Spot Removal, Melasma, Mask of pregnancy

Conditions Treated

Sun damaged skin, prematurely aged skin, finely wrinkled skin, irregular or non-uniform skin color, dull complexion, acne prone skin types, and melasma.

Treatment overview

The freshening peel is accomplished with relatively mild agents such as glycolic acid, Jessner’s solution, salicylic acid, or low strength Trichloroacetic Acid (TCA). The goal of these peels is to produce superficial effects, with little irritation, mild redness and no downtime. With a series of 3-6 peels at 2-4 week intervals, a smoother texture and more even skin tone can be expected. 

The Procedure

Following pre-treatment photographs and cleansing, the peeling agent is applied to the entire face. A mild tingling or burning sensation may be experienced during the treatment, but the discomfort is usually transitory and well tolerated. Discomfort of variable severity may be present for a couple of hours after the peel and is easily relieved by cold compresses. Mild redness and minimal swelling or peeling can be expected after the procedure.

Post-Treatment

Following the treatment a sunscreen of SPF 30 or higher is mandatory. 

Dermal Fillers (Soft Tissue Augmentation) at Pima Dermatology

Treats: Wrinkle correction, Structural loss, Volume loss

Conditions Treated

Wrinkle correction, Structural loss, Volume loss

Types of Fillers Pima Dermatology Offers

  • Restylane by Medicis, is a non-animal derived hyaluronic acid that corrects structural line, scarring, wrinkles, and is able to define the lip line. Lasts approximately 6-9 months.
  • Perlane by Medicis, requires no skin test, is also non-animal derived hyaluronic acid that corrects volume, scarring and wrinkles. Lasts approximately 6-9 months.
  • Juvederm by Allergan requires no skin test, is a non-animal derived hyaluronic acid and corrects volume, scarring and wrinkles. Lasts approximately 6-12 months.
  • Cosmoderm and Cosmoplast by Inamed are human derived collagen, which correct volume, scarring, wrinkles and is able to define the lip line. Lasts up to 3 months.

Procedure

Topical numbing will be applied at the time of appointment. A dental block is also an option for patients who are having their lips treated.

Common side effects

Bruising can occur at injection sites. 

Eczema (Dermatitis) at Pima Dermatology

Condition Overview

A very common condition affecting all ages and characterized by sensitive skin which becomes easily inflamed, red, scaly and itchy. The word ‘atopic’ means there is a genetic tendency for excess inflammation in the skin resulting in Eczema and a positive sensitivity in the lungs (asthma) and nose causing hay fever. Eczema may be present on the face in infants, on creases and folds in young children, and in localized areas such as hand dermatitis or in more generalized areas on adults.

Causes

Eczema often runs in families with sensitive skin, allergies, asthma or hay fever. Skin irritants may cause flares and a tendency to itch and scratch, which promotes the disease. Eczema is termed the ‘itch that rashes’.

Symptoms

Red, scaly, crusted, oozing, blistering, brownish plaques on the skin. Chronic areas become thickened due to intractable itching. Areas may become crusted and infected. 

Treatments

Try to avoid any irritants. Use cool short baths or showers, mild unscented soap, and frequent moisturization with hypoallergenic creams, lotions and ointments.

Melanoma - Signs & Symptoms at Pima Dermatology

Causes

Melanoma is linked to certain types of moles, and may appear on skin that is not exposed to the sun. Atypical moles are an inherited trait in some families, and may turn into melanomas, or serve as a marker to identify an individual who has a higher risk for melanoma.

Condition Overview

Melanoma begins in the melanocytes, the cells that produce skin color. When you are exposed to the sun, the melanin in your skin increases and causes your skin to darken. Melanoma is melanocytes that have been transformed into cancer cells and grow abnormally. These cancer cells can spread to vital internal organs and grow, making it more difficult to treat and much less likely to cure. Melanoma may appear without warning, which is why it is important to know the color, size and location of the moles on your body, and to recognize changes in your moles.

Recognizing the early warning signs for changing moles: ABCD’s

    A  Asymmetry: One half does not match the other half.

    B  Border: The border or edges of the mole are ragged, blurred or irregular.

    C  Color: The color of the mole is not the same throughout.

    D  Diameter: While melanomas are usually greater than 6mm, the size of a pencil eraser, melanoma can be smaller.

Other warning signs for changing moles

  • A change in size, shape or color of a spot or mole
  • A sore that does not heal
  • A new growth
  • Redness, itchiness, scaliness, bleeding or appearance of a bump or nodule
Melasma Overview at Pima Dermatology

Causes: Genetic Predisposition, Pregnancy, Birth Control Pills, Hormone Pills, Progesterone, Hormone Replacement Therapy. 

Condition Overview

Melasma is light to dark brown, irregular, patchy pigmentation of the face. It is slow to develop and most commonly affects women with darker skin types. There are different types of melasma: 

  • Superficial (epidermal)
  • Deeper Type (dermal)
  • Combination of Both Types 

At Pima Dermatology, a special light is used to check the face in an attempt to ascertain the depth and degree of the melasma.  This helps us to choose the right treatment for our patient.

Treatments

  • Bleaching Agents – With active ingredients in the primary bleaching agents that include: Hydroquinone, Kojic Acid, and Azelaic Acid (Azelex, or Finevin)
  • Retinoids– Retin-A, Renova, Differin, Tazorac
  • Glycolic Acids in the form of cleansers, lotions, and creams
  • Chemical and Freshening Peels
  • Microdermabrasion
  • Laser Treatments
Microdermabrasion at Pima Dermatology

Treats: Acne Scarring, Adult Acne, Wrinkles, Age spots

Treatment Overview

Microdermabrasion can provide a substantial improvement in certain types of scars, stretch marks, aged and sun-damaged skin. A fine beam of aluminum oxide microcrystals or a mechanical device without crystals is used to precisely and superficially peel the skin’s surface. The main advantage of this technique is that it is gentle and requires no significant change in a patient's usual activities. The best results usually require multiple treatment sessions.

Conditions Treatable with Microdermabrasion

  • Fine lines and wrinkles
  • Age spots/superficial pigmentation
  • General exfoliation/rejuvenation
  • Acne scars
  • Enlarged or oily pores
  • Blackheads and whiteheads
  • Post-traumatic pigmentation
  • Adjunctive to cosmetic surgery
  • Blending post-Lasered skin

Procedure Overview

Microdermabrasion with a gently abrasive hand piece, delivers a controlled, mechanized, exfoliation of the upper most, scaly surface skin layer. The treatment typically lasts 15-20 minutes, during which a vacuum like action, which creates mild inflammation to deeper dermal skin layers, which helps to stimulate new collagen formation.

 

Mohs Surgery for Skin Cancer at Pima Dermatology

Treats: BCC, Basal Cell Carcinoma, Melanoma

Treatment Overview

Mohs Micrographic Surgery is an advanced technique for treating skin cancer that will remove all the cancer, minimize the risk of recurrence, and leave as little scarring as possible.  It relies on the accuracy of a map of the diseased tissue area and the precision of a microscope to trace out and complete removal of the cancer- down to its roots.

Types of Cancer Most Likely to Warrant Mohs Surgery

  • Cancers located in cosmetically sensitive or functionally critical areas around the eyes, nose, lips, scalp, fingers, toes or genitals.
  • Large, aggressive, or rapidly growing cancers.
  • Recurrent Cancers

The Mohs Surgery Process*

  • Step 1: The roots of a skin cancer may extend beyond the visible portion of the tumor. If these roots are not removed, the cancer will recur.
  • Step 2: The visible portion of the tumor is surgically removed.
  • Step 3: A layer of skin is removed and divided into sections. The Mohs surgeon then color codes each of these sections with dyes and makes reference marks on the skin to show the source of these sections. A map of the surgical site is then drawn.
  • Step 4: the undersurface and edged of each section are microscopically examined for evidence of remaining cancer.
  • Step 5: If cancer cells are found under the microscope, the Mohs surgeon marks their location on to the map and returns to the patient to remove another layer of skin- but only from precisely where the cancer cells remain.
  • Step 6: The removal process stops when there is no longer any evidence of cancer remaining in the surgical site. Because Mohs surgery removes only tissue containing cancer, it ensures that the maximum amount of healthy tissue is kept intact.

*Mohs surgery process is reprinted from the ‘Mohs Micrographic Surgery’ brochure, published by the American College of Mohs Surgery (ACMS)

This treatment is for: 

  • Basal Cell Carcinoma
  • Melanoma
  • Squamous Cell Carcinoma
Moles (Nevi), Normal
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 Causes

Sun exposure may darken or increase the number of moles. A large number of moles or atypical moles are an inherited trait in some families. 

Condition Overview

Moles are found anywhere on the skin and occur in various sizes and shapes. They are usually brown, but can also be skin colored. The brown pigment in moles is caused by melanocytes, special cells that produce the pigment melanin. At first, a mole can be flat and tan like a freckle, however over time, moles usually enlarge and may develop hairs. 

Recognizing the early warning signs for changing moles: ABCD’s

    A  Asymmetry: One half does not match the other half.

    B  Border: The border or edges of the mole are ragged, blurred or irregular.

    C  Color: The color of the mole is not the same throughout.

    D  Diameter: While melanomas are usually greater than 6mm, the size of a pencil eraser,  melanoma can be smaller.

Treatment

When a mole is atypical or showing signs of the ABCDs (see above), a biopsy is recommended.The most common treatment methods are numbing and shaving the mole off, or excising the mole and then closing it with stitches.

Psoriasis Overview at Pima Dermatology

Condition Overview

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Thick, red, scaly, well-demarcated plaques on the skin, usually symmetric over extensor surfaces (elbows, knees) or other areas such as scalp, nails, palms and soles. In mild cases, Psoriasis may involve small areas, while moderate to severe cases may involve much of the body surfaces. Psoriasis may also be associated with joint problems and psoriatic arthritis.

Symptoms

Thick red plaques, with silvery scale and constant shedding scale over scalp or body. Psoriasis may be associated with joint inflammation and joint aches. 

Treatments

  • Topical Steroids: Clobetasol, Triamcinalome
  • Topical Vitamin D: Dovonex
  • Topical Retinoids: Tazorac
  • Combination Products: Taclonex (Vitamin-D and a Steroid)
  • Ultra-Violet Light  or Outdoor Sunlight, UVB, Narrow Band UVB or PUVA 
  • Systemic Treatments: Soriatne (Vitamin-A) Methotrexate, Cyclosporine
  • Injectable Biologic Therapy: Enbrel, Humira, Raptiva, Remicode
Seborrheic Dermatitis at Pima Dermatology

Causes

Exact cause is unknown

Condition Overview

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Seborrheic keratoses are non-cancerous growths of the outer skin layer. SKs occur singly or in a cluster and are usually brown in color, SKs can vary from tan to black.  SKs have a waxy, almost pasted-on look. Almost every adult will eventually develop at least of few of these growths as they are more common with aging. 

Treatments

Cryotherapy or Liquid Nitrogen therapy freezes the SKs. Repeat treatment may be necessary at two week intervals.

Curettage and Electrodessication: the growth is peeled away with a curette and the heat produced by an electrocautery needle destroys the SK and controls bleeding.

Squamous Cell Carcinoma (SCC) at Pima Dermatology

Also Known As: SCC

Causes

Chronic exposure to the sun is the cause of almost all SCCs, which most commonly occur on exposed parts of the body—the face, ears, neck, scalp, shoulders, and back. The rim of the ear and the lower lip also are especially susceptible to the development of these cancers. 

Condition Overview

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SCC is the second most common skin cancer after Basal Cell Carcinoma and afflicts more than 200,000 Americans each year. This cancer may occur on all areas of the body, but most commonly on the sun-exposed skin. Rarely SCC can spread or metastasize to other areas and organs and can become fatal. Lesions on the lip and advanced large lesions are at the highest risk to spread.

 Warning Signs of Squamous Cell Carcinoma

  • A Reddish Patch or irritated area frequently occurring on the face, chest, shoulders, arms, or legs. Sometimes the patch crusts and it may also itch. At other times, the patch persists with no noticeable discomfort.
  • An Elevated Growth with a central depression that occasionally bleeds. A growth of this type may rapidly increase in size.
  • A Wart-Like Growth that crusts and occasionally bleeds
  • An Open Sore that bleeds, oozes, or crusts and remains open for a few weeks only to heal up and then bleed again. A persistent, non-healing sore is a very common sign of an early BCC.

Treatment: 

The choice of treatment is based on the type, size, location, and depth of penetration of the tumor, as well as the patient’s age and general health. 

  • Curettage and Electrodesiccation: The growth is peeled away with a curette and the heat produced by an electrocautery needle destroys the residual tumor and controls bleeding.
  • Excisional Surgery: The growth is cut out and then closed with stitches.
  • Mohs Micrographic Surgery: Microscopically controlled excisions. This technique minimizes removal of normal skin and is reserved for large recurrent or difficult to treat areas of the skin.
Warts at Pima Dermatology

Also known as: Seed Warts, Plantar Warts

Causes

Warts are indirectly passed from person-to-person and are caused by the Human Papilloma Virus or HPV.

Condition overview

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Warts are non-cancerous, skin-colored growths caused by a virus in the top layer of the skin. Warts may appear as rough, surfaced, thickened lesions or, on occasion, are flat and smooth. Warts can be present singly or in a cluster (Mosaic Warts) such as around fingernails or soles of feet.

There are multiple types of warts:

  • Common Warts usually grow on the fingers, around the nails, and on the backs of the hands.
  • Foot (Plantar) Warts
  • Flat Warts are smaller and smoother than other warts, and grow in large numbers anywhere on the body.
  • Water Warts (Molluscum)
  • Genital Warts

Symptoms

Enlarging, rough, surfaced viral lesions that may become infected, bleed, or become sore. 

Treatment

Topical Home Treatments

  • Salicylic Acid (Duofilm)
  • Aldera Cream

In-Office Treatments

  • Cantharidin which causes a blister to form under the wart. This treatment is usually repeated after several weeks.
  • Cryotherapy or Liquid Nitrogen Therapy freezes the warts. Repeat treatments may be necessary at two week intervals.
  • Surgical Removal  
  • Laser Surgery with the Pulsed Dye Laser is used for resistant warts that have not responded to other therapies. This Laser works by targeting and interrupting blood vessels that supply the wart. Multiple treatments may be necessary.

Patient Education Resources

Acne at Pima Dermatology
Also known as: Cystic Acne, Teenage Acne, Adult Acne, Acne Rosacea, Pimples, Cysts, Zits, Whiteheads, Red Face, Blackheads, Nodules, Scars Condition Overview Acne is a skin condition characterized by plugged pores, red pimples, nodules, and cysts which can result in scarring.  There are many types of acne: Cystic Acne is deep “pus-filled” lumps on the skin. Teenage Acne is formed by testosterone, a hormone present in males and females, which stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug the pores causing whiteheads, blackheads and pimples. Adult Acne may be related to hormones, childbirth, or menopause. Acne Rosacea is acne associated with Rosacea. Causes Acne is caused by different factors: Genetics Hormones Mechanical or frictional factors such as a football player’s helmet strap Occlusive oils that lead to plugged pores  Symptoms of Acne Red, painful pustules, pimples, or nod...
Atopic Dermatitis Overview at Pima Dermatology
Eczema, also referred to as “atopic dermatitis” is a very common condition affecting all ages and characterized by sensitive skin which becomes easily inflamed, red, scaly and itchy. The word ‘atopic’ means there is a genetic tendency for excess inflammation in the skin resulting in Eczema and a positive sensitivity in the lungs (asthma) and nose causing hay fever. Eczema may be present on the face in infants, on creases and folds in young children, and in localized areas such as hand dermatitis or in more generalized areas on adults. Eczema often runs in families with sensitive skin, allergies, asthma or hay fever. Skin irritants may cause flares and a tendency to itch and scratch, which promotes the disease. Eczema is termed the ‘itch that rashes’. Symptoms: Red, scaly, crusted, oozing, blistering, brownish plaques on the skin. Chronic areas become thickened due to intractable itching. Areas may become crusted and infected. Treatments: ...
Find the Right Laser for You at Pima Dermatology
  Lasers offer a unique way to treat a wide variety of skin problems with minimal pain and invasiveness. Your Problem Your Solution Acne Smoothbeam Laser Acne Scarring Carbon Dioxide (CO2) Laser, Erbium: YAG Laser, Gentle:YAG, Pulsed Dye Laser, QuadraLASE Carbon Dioxide Laser, SmartXide DOT Laser, Smoothbeam Laser, StarLux Fractional Resurfacing Erbium Laser, Vbeam Pulse Dye Laser Hemangioma Pulsed Dye Laser, Vbeam Pulse Dye Laser Poikiloderma ("Red Neck") StarLux Fractional Resurfacing Erbium Laser, Vbeam Pulse Dye Laser Port Wine Stains Pulsed Dye Laser Psoriasis PHAROS EX-308 Excimer Laser Red Vascular Birthmark Pulsed Dye Laser Rosacea Pulsed Dye Laser, Vbeam Pulse Dye Laser Seborrheic Keratosis Erbium: YAG Laser Stret...
Fractional Lasers Overview at Pima Dermatology
Treats: Wrinkle correction, Wrinkles, Skin aging, Uneven skin tone and color, Irregular skin texture-scars, Scars, Stretchmarks Fractional Skin Resurfacing is a relatively new concept in Laser skin rejuvenation. It allows for partial and precise targeted laser impacts which leave islands of the normal skin surface intact. This computer-aided technology allows for a deep enough laser effect to create the desired  results with less pain and less anesthesia than standard Laser resurfacing. There is less recovery time and faster healing and re-entry into normal daily activities with Fractional Resurfacing. Conditions treated Wrinkles Skin Aging Irregular or Uneven Skin Tone and Color Irregular Skin Texture Scars (especially acne scarring) Stretch marks Ideal Candidates Men or women who have mild to moderate signs of skin aging, fine lines and wrinkles, and mildly lax skin tone. Non-uniform skin tone and color can be corrected as well as textural prob...
Laser Hair Removal Treatment at Pima Dermatology
Treatment At Pima Dermatology we currently have two distinct Lasers for hair removal; the GentleMAX (GentleLASE) and GentleYAG. At the time of your consultation we will discuss the best Laser for your hair and skin type and provide with reasonable expectations for treatment. The GentleMAX (GentleLASE) has the best combination of selective absorption and deeper penetration for fair-skinned patients with dark hair target.  The GentleYAG Lasers are the safest for some dark skinned or tanned patients. Hair Removal Candidates  Individuals with course dark hair, and light skin color respond most optimally. Light energy is absorbed by the pigment melanin, which then is transformed into heat energy to disable the follicle. In those people with darker skin color (more melanin in the skin), the skin tends to compete with the hair for the light energy resulting in the potential for damage to the skin, not the hair follicle.  The competition for the l...
Laser Resurfacing Overview and FAQs
Conditions Treated Laser resurfacing is ideal for treating deep wrinkles around the eyes, mouth, forehead, cheeks and neck, acne scarring and surgical scarring. Ideal Candidates People with sun damaged skin and fine to deep skin wrinkles around the eyes (crow’s feet), mouth (vertical lip lines or smoker’s lines), the entire facial surface and the entire neck and v of the chest are ideal. Patients with acne scarring, other surface scars and irregularities (benign surface growths) are also candidates. Treatment Overview Laser skin resurfacing can be performed as a convenient, simple, in-office procedure in as little as 45 minutes, depending on the size and extent of the areas to be treated. The combination of the CO2 and Erbium:YAG Laser are used for optimal results. We treat patients in an out patient surgical facility under general anesthesia according to patient preference. Used singly or in combination with various chemical peels to blend skin color and tex...
Laser Skin Rejuvenation Treatment at Pima Dermatology
Also known as: Laser skin toning, Non-ablative Laser Remodeling, Skin tightening  Conditions Treated Sun-damaged skin Mottled skin color, dull complexion, skin laxity Red flushed skin (Rosacea) Fine lines and wrinkles Irregular skin texture (Scaly, rough dry skin patches) Scars (Acne scarring or other causes) Aging, red or discolored necks/chest Treatment Overview The goal is to approach the results of Laser Skin resurfacing by using specific Laser and/or light sources on the skin to affect changes both on the surface as well as in deeper structures without creating a wound or significant healing time. The light targets the dermis primarily to create enough inflammation to stimulate and generate new collagen and thereby improve skin quality, tone, texture and laxity. No Downtime Devices Pulsed Dye Lasers (Vbeam) target superficial dermal vessels to create heat in the dermis to stimulate collagen. Infrared Lasers (Gentle:YAG, Sciton and ...
Port Wine Stain Overview at Pima Dermatology
Causes: Unknown Condition Overview Red or burgundy patch on the skin which slowly darkens and thickens in the first  several decades of life which may develop localized thickenings (blebs) which can bleed, or become infected. Unlike Hemangiomas, Port-Wine Stains grow proportionately as the child grows. PWS do not go away by themselves, and will thicken, darken and lead to deformity without treatment. Symptoms Thickened, red/purple or burgundy colored papules over the Port-Wine Stain which may bleed; red/purple facial stain may be associated with seizures, glaucoma, and intellectual and developmental disabilities (Sturge Weber Syndrome). Treatments The Pulsed Dye Laser (Candela Perfecta Laser) is the "Gold Standard" for Port Wine Stain (PWS) treatment and offers several distinctive advantages over other systems. It was specially designed for treatment of the PWS, and for other skin lesions with prominent red blood vessels. This Laser can often b...
Retinoids for Acne at Pima Dermatology
Treats: Acne, Acne Rosacea, Acne Scarring, Actinic Keratosis, Age spots, Solar keratosis, Wrinkles Product Overview Retinoids are medications that are related structurally and/or functionally to Vitamin-A. They work in the treatment of photodamaged skin to decrease fine wrinkles, skin roughness, hyperpigmentation, and other characteristics that increase with age and sun exposure.   Treatment Overview Retinoids are used primarily as anti-acne medication, and with regular use, to improve sun-damaged skin. Initially, Retinoids may irritate the skin causing redness, and peeling which is why it is important to start their use gradually. Start gradually: Start by using the medication 2-3 times weekly, working up to nightly use as tolerated Less is best: Gently rub in the smallest amount possible in a very thin film to all of the areas you would like to treat, avoiding the eyes. A pea-sized amount of medication is appropriate for the entire face. F...
Retinoids for Acne at Pima Dermatology
Treats: Acne, Acne Rosacea, Acne Scarring, Actinic Keratosis, Age spots, Solar keratosis, Wrinkles Product Overview Retinoids are medications that are related structurally and/or functionally to Vitamin-A. They work in the treatment of photodamaged skin to decrease fine wrinkles, skin roughness, hyperpigmentation, and other characteristics that increase with age and sun exposure.   Treatment Overview Retinoids are used primarily as anti-acne medication, and with regular use, to improve sun-damaged skin. Initially, Retinoids may irritate the skin causing redness, and peeling which is why it is important to start their use gradually. Start gradually: Start by using the medication 2-3 times weekly, working up to nightly use as tolerated Less is best: Gently rub in the smallest amount possible in a very thin film to all of the areas you would like to treat, avoiding the eyes. A pea-sized amount of medication is appropriate for the entire face. F...

Conditions Treated

Acne
Aging Skin & Wrinkles
Allergic Contact Dermatitis
Atopic Dermatitis
Hair Loss (Balding)
Psoriasis
Rosacea
Seborrheic Keratosis
Skin Cancer
Warts

Procedures & Services

Biologic Medications for Psoriasis
Botox® Cosmetic
CoolSculpting®
Juvederm®
Laser Resurfacing
Laser Skin Rejuvenation
Laser Treatment for Spider Veins

About Me

Dr. Gerald Goldberg, MD is a board-certified Tucson dermatologist providing care to patients at Pima Dermatology.

Dr. Goldberg has served on the Editorial board of several esteemed dermatologic journals* and was the recipient of the "Physician of the Year" award for community service from the Arizona Medical Association and the "Volunteer Community Service Award" by Children’s and Family Resources, Inc. of Tucson.

Dr. Goldberg is internationally recognized with unique experience in Laser surgery for the treatment of a variety of skin conditions. He is certified in more than 25 laser modalities and  brings his patients expertise based on more than 12,000 Laser surgeries to date.

Dr. Goldberg also serves as Associate Clinical Professor of Dermatology and Pediatrics at the University of Arizona Health Sciences Center.

He has published widely in medical literature and lectured nationally and internationally on a variety of Laser related topics.

Dr. Gerald Goldberg is a member of several esteemed medical professional organizations, including local groups. He serves on the Medical Advisory Board of the Sturge-Weber Foundation, is a Past Board Member of the American Cancer Society / Southern Arizona Chapter, is Past-President of the Tucson Dermatological Society and Sonoran Dermatological Society:

 

Education & Training

Dr. Goldberg graduated cum laude from Princeton University in 1973 and received his medical degree (MD) from the State University of New York (SUNY) at Syracuse, where he was elected to the Alpha Omega Alpha Honor Society. He completed his residency in Pediatrics prior to completing an additional fellowship in Dermatology in 1983.

Pima Dermatology

Pima Dermatology, PC, has proudly served the Tucson, Arizona community for over 30 years. Our board-certified dermatologists employ the latest techniques and advances in skin diagnosis and treatment, specializing in laser treatments and Mohs skin cancer surgery.

We offer medical, surgical, cosmetic, and laser dermatology. Our office features more than 20 on-site Laser modalities, a Mohs lab, narrowband UVB phototherapy, two skin care sales areas, and the VISIA Complexion Analysis. We have a beautiful surgical unit with fully-equipped procedure rooms and comfortable areas for pre and post-operative care.

Our medical dermatology services cover routine skin examinations (annual skin checks) to the extensive treatment of conditions such as acne, eczema, psoriasis, rosacea, warts, and rashes.

Surgical dermatology procedures include skin cancer surgery (often using Mohs surgery for the most complex skin cancers) and laser treatments of various birthmarks.

In the area of cosmetic dermatology, our new Laser + Cosmetic Center (adjacent to the medical side of our practice) offers patients the opportunity to achieve their aesthetic goals in a safe and beautiful, ambulatory-care certified space. We provide a full range of cosmetic offerings such as, dermal filler injections, Botox®, CoolSculpting®, Platelet-Rich Plasma (PRP) facial rejuvenation, various peels, microdermabrasion, dermaplaning, the VISIA Complexion Analysis, and more.

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