David J Goldberg

Icahn School of Medicine at Mount Sinai, Manhattan, New York, United States

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Publications (11)14.58 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: IMPORTANCE Excisional skin cancer surgery is a common procedure, with no formal consensus for mitigating the risk of wrong-site cutaneous surgery. OBJECTIVE To systematically consider the usefulness and feasibility of proposed methods for correct biopsy site identification in dermatology. EVIDENCE REVIEW Survey study with a formal consensus process. Item development was via a literature review and expert interviews, followed by 2 stages of a Delphi process to develop consensus recommendations. FINDINGS In total, 2323 articles were reviewed in the literature search, with data extraction from 14. Twenty-five experts underwent 30-minute structured interviews, which were transcribed and coded. The resulting survey was composed of 42 proposed interventions by multiple stakeholders (biopsying physicians, operating physicians, nurses, ancillary staff, patients, caregivers, and family members) at 3 time points (day of biopsy, delay and consultation period, and day of definitive surgery). Two rounds of a Delphi process with 59 experts (25 academic and 34 private practice) scored the survey. Strong consensus was obtained on 14 behaviors, and moderate consensus was obtained on 21 other behaviors. In addition, a 2-state simultaneous algorithm was developed to model surgeon behavior on the day of definitive surgery based on surgeon and patient perceptions. CONCLUSIONS AND RELEVANCE When definitive surgery is performed after the initial biopsy and by a different surgeon, procedures can be implemented at several time points to increase the likelihood of correct site identification. The specific circumstances of a case suggest which methods may be most appropriate and feasible, and some may be implemented. The risk of wrong-site cutaneous surgery can be reduced but not eliminated.
    JAMA dermatology. 03/2014;
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    ABSTRACT: BACKGROUND: A minimally invasive fractional bipolar radiofrequency (FRF) was developed. OBJECTIVE: To evaluate safety and efficacy of FRF in reducing face and neck rhytides and laxity. MATERIALS AND METHODS: This prospective, open-label, multicenter clinical trial enrolled 100 subjects with mild to severe facial and neck rhytides and laxity at seven centers in a per-protocol analysis. One single-pass FRF treatment was administered through five 32 g-needle electrode pairs at a preselected real-time fixed temperature of 62 to 78°C, energy duration for 3 to 5 seconds, and impedance restrictions of 200 to 3,000 Ohms, ensuring intradermal delivery. Five blinded dermatologists and plastic surgeons graded randomized standardized baseline and follow-up photographs of 53 and 42 subjects at 3- and 6-month follow-up intervals, respectively, using the Fitzpatrick wrinkle and Alexiades-Armenakas laxity scales. Subject assessments and adverse events were recorded in 100 subjects. RESULTS: Blinded evaluations revealed correct pre- and post-treatment identification in 100% of scored cases, mean improvement of 25.6% on the Fitzpatrick Wrinkle Scale and 24.1% on the Alexiades-Armenakas laxity scale at 6 months, and 100% response rate for rhytides and 95% for laxity. Subgroup analysis revealed maximal rhytid reduction in the mean target temperature of 66.7, energy duration of 4.2 seconds, and volume of denatured collagen of mm(3) denatured collagen group. Adverse events included transient erythema, edema, and ecchymoses, resolving within 1 to 5 days, and two incidents of temporary pinpoint depressions. More than 90% of subjects were satisfied or very satisfied. CONCLUSION: Real-time temperature-controlled FRF is a highly reproducible, safe, effective nonsurgical treatment of face and neck rhytides and laxity and provides important insights into neocollagenesis, neoelastogenesis, and clinical outcomes.
    Dermatologic Surgery 12/2012; · 1.87 Impact Factor
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    ABSTRACT: Part I of this two-part supplement brings together experts from the U.S., Europe, Canada, and Israel to discuss the state-of-the-art in soft tissue fillers in a fair-balanced, CME-accredited format. It includes a roundtable discussion on hyaluronic acid (HA) fillers that charts the clinical and scientific path that has led dermatologists from wrinkle-chasing to true volumetry. International case vignettes with commentary highlight a variety of applications for fillers'some currently available in the U.S., and some available elsewhere and on the American horizon. Topics covered include single-product and multi-product volumetry, anatomic and safety considerations, and the use of blunt injection microcannulas. Quick poll surveys provide an engaging snapshot of the faculty's personal approaches, with the first three surveys focusing on the palette of HA fillers. This is a CME supplement; visit the JDD Medical Education Library to participate in this activity and earn 2 AMA PRA Category 1 Credits.
    Journal of drugs in dermatology: JDD 03/2012; 11(3):5-50. · 1.16 Impact Factor
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    Lasers in Surgery and Medicine 01/2011; 43(1). · 2.46 Impact Factor
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    ABSTRACT: Dermal gel extra (DGE) is a new, tightly cross-linked hyaluronic acid (HA)-based dermal filler containing lidocaine engineered to resist gel deformation and degradation. To develop a firmer gel product (DGE) and compare the efficacy and safety of DGE with nonanimal stabilized HA (NASHA) for correction of nasolabial folds (NLFs). DGE physical properties were characterized, and 140 subjects with moderate to deep NLFs were treated with DGE and NASHA in a randomized, multicenter, split-face design study. Efficacy, pain, and satisfaction were measured using appropriate standard instruments. Adverse events were monitored throughout the study. DGE has a higher modulus and a higher gel:fluid ratio than other HA fillers. Similar optimal correction was observed with DGE and NASHA through 36 weeks (9 months). Study subjects required less volume (p<.001) and fewer touch-ups (p=.005) and reported less injection pain (p<.001) with DGE treatment. Most adverse events were mild to moderate skin reactions. DGE is a firm HA gel that required significantly less volume and fewer touch-ups to provide equivalent efficacy to NASHA for NLF correction; both dermal gels were well tolerated. DGE will provide a comfortable and cost-effective dermal filler option for clinicians and patients.
    Dermatologic Surgery 11/2010; 36 Suppl 3:1833-41. · 1.87 Impact Factor
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    ABSTRACT: Q-Switched Nd:YAG lasers produce photoacoustic effects in addition to photothermal effects which may allow for greater tissue collagen production. The objective of the study is to determine the effectiveness and tolerability of an Electro-Optic (EO) Q-switched Nd:YAG laser with Single Pulse and novel Double Pulse (DP) options in the treatment of photodamaged skin. Sixteen subjects with photoaging were enrolled in this prospective, randomized, split-faced study. Subjects received 6 bi-weekly laser treatments. One half of the face was treated with a Single Pulse while the other half was treated with energies divided into a DP. Blinded investigators and subjects assessed improvement after the sixth treatment for wrinkles, coarseness, pigmentation, redness, laxity, comedones, pore size, and overall skin condition. Subjects also rated the tolerability of the treatments. For the Single Pulse side of the face, the investigators rated 33% of the patients as having a good to excellent (51% or greater) improvement in the overall condition of the skin while 47% of the subjects reported these levels. On the DP side, the overall improvement was good to excellent at a 27% rate by the investigators and 54% by the subjects. Distributions of improved ratings among investigators and subjects were similar for both sides of the treatment area. The majority of stinging/burning sensations during treatment were reported as mild on the DP side (62.8%) and moderate (63.8%) on the Single Pulse side. The chance of reporting none or only mild stinging/burning sensation during treatment was four times greater on the side of the face treated with the DP (P < 0.0001). Results have shown that treatment with the EO QS Nd:YAG laser provides a safe and effective method of skin rejuvenation with the additional benefit of significantly lower patient discomfort during use of the DP mode.
    Lasers in Surgery and Medicine 10/2010; 42(8):699-705. · 2.46 Impact Factor
  • Walfre Franco, Amogh Kothare, David J Goldberg
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    ABSTRACT: The objective of the present study was to demonstrate the feasibility of varying the size of the heating volume of subcutaneous adipose tissue using a novel radiofrequency (RF) technology that controls the delivered energy distribution on the skin surface. Changes in the distribution of the electric potential at the skin surface due to frequency adjustment of a novel RF device were experimentally characterized on human skin at 500 kHz, 1, 2, 3, and 4 MHz. These measurements were used to model RF-induced electric fields and power absorption. Thermal measurements in ex vivo animal models were used to complement the initial mathematical modeling. At 500 kHz the electric potential on the skin surface was nearly constant across the RF applicator surface. At 4 MHz the electric potential dropped 30% from the center to the edge of the RF applicator. At the centerline of the RF applicator, modeling shows that within a 3 cm subcutaneous fat layer the absorbed power at the bottom layer was 40% less than that at the top for 500 kHz. The absorbed power decreased 80% for 4 MHz. Temperature measurements show uniform heating across a horizontal array of probes with 500 kHz. Temperatures were significantly higher at the center probes for 4 MHz. Cross-sectional radiometric temperature maps show a larger heated tissue cross-section using 500 kHz as opposed to 4 MHz. As the frequency increases (i) the electric potential at the skin surface decreases from the center to the edge of the RF applicator; (ii) the difference between the power absorbed at the top and bottom of the subcutaneous fat layer increases; (iii) the difference between the power absorbed at the center and the periphery of the exposed subcutaneous fat volume also increases; and, consequently, (iv) the size of the heated subcutaneous fat volume decreases. Such a device when used in humans may allow for differential delivery of heat to varying fat thicknesses and anatomic areas.
    Lasers in Surgery and Medicine 12/2009; 41(10):745-50. · 2.46 Impact Factor
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    ABSTRACT: A new U.S. Botulinum toxin type A (BoNT-A) has been shown to be safe and effective when administered once, but there is a paucity of clinical evidence regarding long-term use. To evaluate the long-term efficacy and tolerability of repeated treatment with BoNT-A in the correction of moderate-to-severe glabellar lines. STUDY DESIGN/METHODOLOGY: Multicenter, phase 3, randomized, placebo-controlled, double-blind study comparing the efficacy of BoNT-A (50 units) with placebo upon re-treatment of glabellar lines following two-to-three cycles of open-label BoNT-A treatment in 311 patients. At endpoint, BoNT-A produced a significantly higher proportion of responders versus placebo. The incidence of treatment-emergent adverse effects (TEAEs) was slightly lower during additional treatment cycles; the frequency was comparable between BoNT-A and placebo groups. Multiple treatment cycles of BoNT-A were well tolerated in the majority of patients, and there was no tachyphylaxis seen during the study duration of up to 23 months.
    Journal of drugs in dermatology: JDD 06/2009; 8(5):439-44. · 1.16 Impact Factor
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    ABSTRACT: Photodynamic therapy (PDT) has significant promise in improving outcomes of patients with a variety of cutaneous conditions. A group of experts met to review the principles, indications, and clinical benefits of PDT with 5-aminolevulinic acid (ALA). They also reviewed PDT with methyl aminolevulinate. The experts established consensus statements for pretreatment, posttreatment, ALA contact time, light sources, and numbers of sessions associated with ALA PDT for actinic keratosis and superficial basal cell carcinoma, photorejuvenation and cosmetic enhancement, acne, sebaceous skin, rosacea, and rhinophyma. They based consensus recommendations on their clinical experience and the medical literature. They also suggested future applications of ALA PDT. Experts concluded that ALA PDT is a safe and effective modality for the treatment of conditions commonly encountered in dermatology. Since downtime is minimal, the technique is suitable for patients of all ages and lifestyles. Appropriate light sources are available in many dermatology offices. The expanding clinical and financial benefits of PDT justify the purchase of an appropriate light source.
    Journal of drugs in dermatology: JDD 03/2006; 5(2):140-54. · 1.16 Impact Factor
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Publication Stats

67 Citations
14.58 Total Impact Points

Institutions

  • 2009–2012
    • Icahn School of Medicine at Mount Sinai
      • Department of Dermatology
      Manhattan, New York, United States
  • 2006
    • University of British Columbia - Vancouver
      Vancouver, British Columbia, Canada