Ocular malignancies, encompassing both childhood and adult cancers such as retinoblastoma and uveal melanoma, are rare but pose significant challenges to the medical community and affected individuals (Dimaras et al., 2012; Singh et al., 2011). Only a few new cases are diagnosed yearly, making it difficult to gather large-scale data and conduct comprehensive epidemiological studies (Rodriguez-Galindo et al., 2015; Virgili et al., 2017). The Surveillance, Epidemiology, and End Results (SEER) program, a major source of cancer data in the United States, covers only 10-30% of the population (Howlader et al., 2021). This limited coverage may not fully represent the national incidence, prevalence, and outcomes of ocular malignancies.

The rarity of ocular malignancies and reporting delays by cancer registries contribute to variability in incidence rates from year to year (Rodriguez-Galindo et al., 2015; Virgili et al., 2017). This variability can make identifying trends or patterns in disease occurrence is challenging. Early detection is crucial for improving treatment outcomes and minimizing complications (Dimaras et al., 2012; Singh et al., 2011). However, recognizing early symptoms of ocular malignancies can be difficult, leading to delayed diagnoses and potentially worsening prognoses.

The incidence and outcomes of ocular malignancies can vary across different geographic regions and demographic groups (Rodriguez-Galindo et al., 2015; Virgili et al., 2017). Socioeconomic factors, access to healthcare, and genetic factors may contribute to these disparities. There is limited data on long-term outcomes due to the rarity of ocular malignancies and the relatively recent advances in treatment (Friedman et al., 2018; Kaliki & Shields, 2017). Identifying and understanding risk factors for ocular malignancies, such as genetic and environmental factors, remains an ongoing challenge (Linn Murphree, 2005; Singh et al., 2011).

Projects like COMET-USA can help address these challenges by gathering valuable data and insights on both childhood and adult ocular malignancies. This information is essential for improving prevention, diagnosis, and treatment strategies, ultimately enhancing outcomes for affected individuals and their families.


  • Dimaras, H., Kimani, K., Dimba, E. A., Gronsdahl, P., White, A., Chan, H. S., & Gallie, B. L. (2012). Retinoblastoma. The Lancet, 379(9824), 1436-1446.
  • Singh, A. D., Turell, M. E., & Topham, A. K. (2011). Uveal melanoma: trends in incidence, treatment, and survival. Ophthalmology, 118(9), 1881-1885.
  • Rodriguez-Galindo, C., Orbach, D. B., & VanderVeen, D. (2015). Retinoblastoma. Pediatric Clinics of North America, 62(1), 201-223.
  • Virgili, G., Gatta, G., Ciccolallo, L., Capocaccia, R., Biggeri, A., Crocetti, E., & Lutz, J. M. (2007). Incidence of uveal melanoma in Europe. Ophthalmology, 114(12), 2309-2315.
    Howlader, N., No


The COMET-USA project aims to address key aspects of ocular malignancies with a focus on high precision in the following areas:

  • Incidence: The project will provide a detailed analysis of the incidence of ocular malignancies in the United States, accounting for age, sex, ethnicity, and geographic location. This in-depth examination will better understand disease occurrence and help identify populations at higher risk.
  • Survival: COMET-USA will analyze survival rates for patients with ocular malignancies, considering factors such as tumor stage, treatment modalities, and follow-up duration. A precise assessment of survival outcomes can inform clinical decision-making and facilitate the development of more effective treatment strategies.
  • Trends: The project will track trends in ocular malignancies over time, including changes in incidence, survival, and treatment approaches. Identifying emerging patterns and shifts in disease burden can help inform public health policies and guide resource allocation to improve patient outcomes.
  • Disparities: COMET-USA will investigate disparities in the incidence, diagnosis, treatment, and outcomes of ocular malignancies across different population groups. By understanding the underlying factors contributing to these disparities, such as socioeconomic status, access to healthcare, and genetic predisposition, the project can inform targeted interventions to address inequities and improve patient outcomes.
  • Second malignancies: The project will examine the risk of second malignancies in patients with ocular cancers, considering treatment type, genetic predisposition, and lifestyle factors. Understanding the risk of second malignancies can inform long-term follow-up strategies, guide patient counseling, and support the development of interventions to mitigate this risk.

By focusing on these key areas with high precision, the COMET-USA project aims to generate valuable insights into the epidemiology of ocular malignancies. These insights can inform clinical practice, public health policies, and research priorities, ultimately improving prevention, diagnosis, treatment, and outcomes for patients with ocular malignancies.

The acronym stands for :

  • C – Characteristics
  • O – Ocular
  • M – Malignancies
  • E – and (representing ‘and’ between Ocular and Orbital)
  • T – Orbital (using ‘T’ from ‘orbital’ to maintain readability)
  • USA – In the USA


  1. Abdelazeem B, Abbas KS, Shehata J, El-Shahat NA, Eltaras MM, Qaddoumi I, Alfaar AS. Survival trends for patients with retinoblastoma between 2000 and 2018: What has changed? Cancer Med. 2023 Mar;12(5):6318-6324. doi: 10.1002/cam4.5406. Epub 2022 Dec 8. PMID: 36479934; PMCID: PMC10028055.
  2. Abdelazeem B, Abbas KS, Shehata J, Alfaar AS. Increased Risk of Subsequent Skin Melanoma in Patients with Retinoblastoma: SEER-Based Results. J Invest Dermatol. 2022 Nov;142(11):3123-3125. doi: 10.1016/j.jid.2022.04.013. Epub 2022 Sep 14. PMID: 36273838.
  3. Alfaar A, Saad A, Chlad P, Elsherif OE, Elshami M, Busch C, Rehak M. Uveal melanoma and marital status: a relationship that affects survival. Int Ophthalmol. 2022 Dec;42(12):3857-3867. doi: 10.1007/s10792-022-02406-2. Epub 2022 Jul 11. PMID: 35821361; PMCID: PMC9617958.
  4. Alfaar AS, Saad A, Elzouki S, Abdel-Rahman MH, Strauss O, Rehak M. Uveal melanoma-associated cancers revisited. ESMO Open. 2020 Nov;5(6):e000990. doi: 10.1136/esmoopen-2020-000990. PMID: 33257317; PMCID: PMC7705551.
  5. Alfaar AS, Saad AM, KhalafAllah MT, Elsherif OE, Osman MH, Strauß O. Second primary malignancies of eye and ocular adnexa after a first primary elsewhere in the body. Graefes Arch Clin Exp Ophthalmol. 2021 Feb;259(2):515-526. doi: 10.1007/s00417-020-04896-1. Epub 2020 Sep 1. PMID: 32870371; PMCID: PMC7843581.
  6. Alfaar AS, Hassan WM, Bakry MS, Qaddoumi I. Neonates with cancer and causes of death; lessons from 615 cases in the SEER databases. Cancer Med. 2017 Jul;6(7):1817-1826. doi: 10.1002/cam4.1122. Epub 2017 Jun 22. PMID: 28639735; PMCID: PMC5504346.
  7. Hassan WM, Bakry MS, Hassan HM, Alfaar AS. Incidence of orbital, conjunctival and lacrimal gland malignant tumors in USA from Surveillance, Epidemiology and End Results, 1973-2009. Int J Ophthalmol. 2016 Dec 18;9(12):1808-1813. doi: 10.18240/ijo.2016.12.18 PMID: 28003984; PMCID: PMC5154997.
  8. Hassan WM, Alfaar AS, Bakry MS, Ezzat S. Orbital tumors in USA: difference in survival patterns. Cancer Epidemiol. 2014 Oct;38(5):515-22. doi: 10.1016/j.canep.2014.07.001 . Epub 2014 Jul 20. PMID: 25052531.