User:14mfm5/sandbox

Hi Morgyn,

looks pretty good. just a minor suggestion, when you talk about Advanced stage, you should mention systemic metastasis and putting it in lay terms.

Also, did you have a chance to check the survival data quoted for different stages? are they up to date?

Hi Dr. Wang

Thank you for the feedback! I've updated the line on advanced stage. I did check the survival data quoted for different stages, as mentioned in Assignment #3 I'm unable to find the same statistics in the literature. The references are not up to date and unfortunately I can't find my own statistics on survival rate. This is why I have removed them from the article.

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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

Assignment #2
1) How you searched for a source (search strategy – where you went to find it).

I searched “cancer staging merkel cell carcinoma” in PubMed, and selected for review articles published within the past 5 years, in English, using human data.

2) What potential sources were identified and considered (give examples of 1 or 2).

Coggshall, K., Tello, T. L., North, J. P., & Yu, S. S. (2018). Merkel cell carcinoma: An update and review: Pathogenesis, diagnosis, and staging. Journal of the American Academy of Dermatology, 78(3), 433-442. doi:10.1016/j.jaad.2017.12.001

3) Why the source was chosen (what made it better than other choices).

This article was recently published (March 2018) in the Journal of the American Academy of Dermatology. It is organized into the following headings: epidemiology, pathogenesis, clinical presentation, and diagnostic evaluation, staging and prognostic markers. The section on staging highlights the revised American Joint Committee on Cancer staging system.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

This article uses up-to-date evidence

There are no conflicts of interest stated in the article

This article has high evidence quality (it is a systematic review, therefore a secondary source synthesized from multiple primary sources)

5) How do you plan to use the source for improving the article?

This source provides revisions included in the American Joint Committee on Cancer staging system for MCC (e.g. Stage IIIA now includes patients with occult nodal disease) and makes use of the T, N, M system of cancer staging. This will help me to add more information on the stages of MCC to the article.

Assignment #3
Proposed Changes

I will be adding in a section about cancer staging to preamble the “prognosis” section.

Current Article

Overall, the 5-year survival rate for Merkel cell carcinoma is around 60%. It varies depending on the stages of the cancer. In general, a higher cancer stage correlates with a lower survival rate. For example, National Cancer Data Base has survival rates collected from nearly 3000 MCC patients from year 1996-2000 with 5-year survival rates listed as follows: Stage IA: 80%. Stage IB: 60%. Stage IIA: 60%. Stage IIB: 50%. Stage IIC: 50%. Stage IIIA: 45%. Stage IIIB: 25%. Stage IV: 20%. 5 yr survival may be 51% among patients with localized disease, 35% for those with nodal disease, and 14% with metastases to a distant site.

My Changes

According to the American Joint Committee on Cancer (AJCC), the natural course of MCC is “variable and depends heavily on the stage at diagnosis". Staging of MCC is classified according to the TNM staging system, a notation system that describes the stage of cancer according to the size of the primary tumor (T), the degree of spread to regional lymph nodes (N), and the presence of distant metastasis (M). A combination of T, N, and M stages dictate the final clinical stage group (0, I, IIA, IIB, IIIA, IIIB, IV). Advanced stage (i.e. increased size of the tumor, spreading of the tumor into surrounding and/or distant tissue, and involvement of lymph nodes) is associated with lower survival rates.

Rationale for Proposed Changes

The current article on MCC includes 5-year survival rates among people with MCC according to cancer stage. Unfortunately, there is no mention of the cancer staging system used with this disease or the criteria used to stage MCC. My changes to the article will therefore provide needed context.

Line 1: I added in a quote regarding the variability of the disease and prognostic dependence on the stage at diagnosis to emphasize the importance of staging

Line 2: I introduced the TNM staging system and listed its three criteria

Line 3: I added a concluding sentence that ties in how criteria fit together to determine a final clinical stage and included the seven stages of MCC as per the National Cancer Institute (updated October 2nd 2019)

Line 4: I stated the relationship between cancer stage and survival rate

Removed: "overall, the 5-year survival rate for Merkel cell carcinoma is around 60%" - there is no reference and I cannot find support for this statistic in the literature

Removed: "it varies depending on the stages of cancer" - I clarified this statement and added more detail

Removed: "in general, a higher cancer stage correlated with a lower survival rate" - there is no reference and I cannot find support for this statement in the literature

Removed: "for example, National Cancer Data Base [...]" - the cited source does not include this information and I cannot find support for these statistics in the literature

Removed: "5yr survival may be [...]" - the cited source does not include this information and I cannot find support for these statistics in the literature

Controversy or Varied Opinion

There is ambiguity as to whether stage III of MCC can be divided into IIIA and IIIB. The eighth edition of the AJCC (2017) does not differentiate between IIIA and IIIB however the NCI (2019) does. I am including the information from the NCI as it was more recently updated in October of 2019.

Critique of Source

My additions to the article are supported by three secondary sources.


 * 1) The AJCC cancer staging manual endorses the TNM cancer staging system, a standardized classification system for evaluating cancer at a population level. This criterion-based system is objective and relies on clear inclusion/exclusion criteria for each stage. The 8th edition (2017) of this publication included non-anatomic (e.g. molecular) factors in an effort to bring about a personalized approach to patient classification. This tells me that this source is continuously updating standards to meet the changing medical knowledge landscape. Due to the standardized nature of the information extracted from this textbook, I am not concerned with authorial bias.
 * 2) The Physician Data Query (PDQ) is a comprehensive cancer information database. The PDQ summary that I have referenced is based on an independent review of medical literature conducted by Editorial Boards made up of cancer experts. Information may therefore be biased by personal experience or selectively included according to board members' opinions. This source is meant only to inform patients and caregivers rather than to provide formal guidelines or recommendations on healthcare decisions. Advantageously, this source is reviewed regularly and updated with new information when available. The version I have consulted was updated October 2019 and therefore includes the most current understanding of MCC.
 * 3) The Dermatologic Clinics journal article is a review article (i.e. a summary of published material on a topic) and is therefore subject to some threat to validity. While the article referenced almost 200 sources, there is no information on the search and/or selection process of the included studies. In one referenced study (JAVELIN Merkel 200 Trial), consultation of Table 1 revealed that the trial had largely been conducted using older, white, male participants, reducing the external validity of the study's conclusion. This is only one example, however it is important to consider bias, not only in individual study results, but also in how authors of the review selected these studies for review. The authors of the review disclosed no conflicts of interest.