140 Miles in the Sun: A Q&A with Robert Nossa, MD

The Ford Ironman World Championship is not for the faint of heart — literally. This grueling race, 140.6 miles of swimming, biking, and running, demands a level of cardiovascular fitness rarely achieved by mere mortals.

The event can also wreak havoc on the skin.

On October 9, 2010, athletes from around the world swam 2.4 miles through ocean waves, biked for 112 miles, then ran a marathon through windy, sun-scorched, lava-covered terrain. Robert Nossa, MD, completed this ultimate endurance test in Kona, Hawaii. Total time: 13 hours, 40 minutes, and 12 seconds, including two stops at aid stations for clothing changes, much-needed food and drink, and sunscreen reapplication, of course.

Dr. Nossa, a dermatologist practicing with The Dermatology Group in Verona, NJ, used this event to raise awareness about skin cancer prevention — and funds for The Skin Cancer Foundation. Through the Foundation’s Tribute Circle, which enables supporters to create a fund that donors can contribute to online, Dr. Nossa has helped raise over $2,100 for the Foundation as of March, 2011.

“As a dermatologist, I treat skin cancer on a daily basis, and part of my job is to educate patients about sun protection,” Dr. Nossa said. “By linking the Ironman to The Skin Cancer Foundation, I hope to encourage patients both to be active and to protect their skin from unnecessary ultraviolet [UV] radiation.”

The triathlon can take up to 17 hours, and the intensive exposure to the sun’s harmful UV radiation that athletes incur can seriously damage the skin. Here, Dr. Nossa discusses his Ironman sun protection strategies with The Skin Cancer Foundation.

Q: How did you maximize sun protection during the competition?

Before the triathlon, I applied sunscreen wipes with SPF 30 broad-spectrum (UVA/UVB) protection to all exposed areas. After the swim, I rinsed off, towel-dried, and then volunteers reapplied sunscreen to me. [During the transition from one event to the next and any elected breaks, participants stop at aid stations to change clothes, rehydrate with water and electrolyte drinks, and eat bananas and nutrition gels. To help keep race times down, volunteers apply sunscreen to the participants.]

During the bike ride, there were aid stations at five-mile intervals. I stopped at mile 58 for sunscreen reapplication. During the swim and the bike ride, I wore lightweight, aerodynamic, cycling shorts, a cycling jersey, and UV- protective sunglasses. After the bike ride I changed into a lightweight running top designed to keep you cool in the heat. The tight weave of all of the clothes kept out more UV radiation than fabrics with loose or open weaves, and the material, a nylon/Lycra combination, provided extra UV protection — synthetic and semi-synthetic fibers offer the greatest sun protection.

Finally, my head was always covered — we wore swim caps in the water and helmets during the bike ride. I also wore a cap during the marathon. A
broad-brimmed hat would have been
more protective still, but they aren’t
feasible for long distance running.
Caps are more aerodynamic. It was
getting dark by the time I started
the marathon, so I didn’t feel I had to
 reapply sunscreen again, but I did wear
 UV-blocking, polarized sunglasses. 

Q: Did you burn at all?

I did get two small crescent-shaped sunburns on my back, right at the edge of my shirt armholes. The volunteer who applied sunscreen to me didn’t quite cover those parts! Always make sure to cover every exposed body area liberally with sunscreen. 

Q: Did you notice if other participants were taking sun safety precautions?

A: Some did. Some participants wore compression sleeves, which are long, sleeve-like sheaths that cover the arm from the wrist to the elbow. They’re made of a high-tech material that keeps you cool and creates a physical barrier from the sun. Some people also wore similar sleeves on the lower legs.

On the other hand, I know several participants who did not stop to reapply sunscreen — they were either more concerned about their race time or thought they were too dark-skinned to burn. Some of them did burn. 

Q: Any areas you’re especially careful to protect?

I’m very conscientious, particularly about the shoulders and upper back, as well as the cheeks, nose, and ears. During the triathlon, there was not a moment when we had cloud cover — there was a strong tropical sun the entire day.

If you’re outdoors and participating in a long endurance event you have to be aware of the risks of sun exposure. Stay sun-protected.


DR . Nossa graduated from the State University of New York at Stony Brook Medical School. He completed an internship in internal medi- cine at Brown University and a dermatology residency at the Mount Sinai School of Medicine in New York. At The Dermatology Group in northern New Jersey, he serves as Director of Clinical Research and Laser Services. He has published widely on topics such as melanoma, nonmelanoma skin cancer, and technology in medicine.