User:Firefly3231/sandbox

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This is place to practice clicking the "edit" button and practice adding references (via the citation button). Please see Help:My_sandbox or contact User_talk:JenOttawa with any questions.

Link: Project Homepage and Resources


 * 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

Merkel cell carcinoma

 Assignment 2 

1) How you searched for a source (search strategy – where you went to find it)? Because Primary sources are not appropriate for Wikipedia, I thought of where to find high- quality secondary sources other than PubMed. High quality point-of-care sources such as Dynamed and BMJ best practice present good quality summary, so I considered these two tools. I also searched medical authorities such as the WHO, the CDC, the Mayo clinic, and the Canadian Cancer society. Lastly, I searched for textbooks used by pathologists who would diagnose Merkle cell carcinoma.

2) What potential sources were identified and considered? (a few examples- this is not exhaustive)

3) Why the source was chosen?

I have chosen the textbook Weedon’s Skin Pathology, as it is the source used by dermatological pathologists. It is a trusted resource by experts in the field, and as such, was adequate to inform the revision of the Wikipedia page.

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

1. 	This source is a textbook, and as such, is considered a secondary source.

2. 	This textbook concisely summarizes scientific consensus

3. 	The textbook does not over-emphasize single studies

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

I am tasked with revising the introduction of the Wikipedia page on Merkel cell carcinoma. This textbook gives a good summary of the current state of knowledge on the topic, and will be a valuable resource to reframe the introduction paragraph to be more clear.

 Assignment 3 

Proposed changes

I intend to simplify the language of the introduction, add information about prevalence and risk factors, and move information related to pathophysiology in a different section. My specific changes are bolded below:

Merkel-cell carcinoma (MCC) is a rare and aggressive skin cancer occurring in about 3 per 1,000,000 population. It is also known as cutaneous APUDoma, primary neuroendocrine carcinoma of the skin, primary small cell carcinoma of the skin, and trabecular carcinoma of the skin. Merkel-cell carcinoma usually arises on the head, neck, and extremities, as well as on the perianal and eyelid. It is more common in elderly people, people who are immunocompromised, and people who were exposed to UV radiation, and less common in children.

The following will be moved to the pathophysiology section:

"About 80% of Merkel-cell carcinomas are caused by MCPyV.[3] Indeed, DNA sequences of Merkel cell polyomavirus (MCPyV) were identified in this tumor [3] The virus is clonally integrated into the cancerous Merkel cells. In addition, the virus has a particular mutation only when found in cancer cells, but not when it is detected in healthy skin cells.[4] Direct evidence for this oncogenic mechanism comes from research showing that inhibition of production of MCPyV proteins causes MCV-infected Merkel carcinoma cells to die but has no effect on malignant Merkel cells that are not infected with this virus.[5][6] MCV-uninfected tumors, which account for about 20% of Merkel-cell carcinomas, appear to have a separate and as-yet unknown cause.[7] Those tend to have extremely high genome mutation rates, due to ultraviolet light exposure, whereas MCV-infected Merkel cell carcinomas have low rates of genome mutation.[8]"

Rationale for proposed changes

The introduction is currently very detailed, high-level, and focused on pathophysiology. Since people reading the Wikipedia page for Merkle-cell carcinoma are likely going to be people with the condition, or family members, it is important for the introduction to be written in a language that is accessible and easily understood. The introduction is the first, and often, the only section people will read, and as such, should give a general overview, and not a dive into small details. Readers interested in more details can then read on to the specific section.

It is unlikely that the changes I have made to the introduction would create controversy, as I have not removed pertinent information from the article, I only moved it to a different section. In addition, I added incidence and risk factors information that is unlikely to be controversial.

Critique of Source

I have used two sources, the Weedon skin pathology textbook 4th edition, and Dynamed. Because Dynamed is similar to a practice guideline, it is important to be aware of red flags, including potential conflict of interest. When reading the affiliation of the authors of the Dynamed page, one of them (Anthony M. Rossi) declares relevant financial relationships with pharmaceutical companies. As such, it is important to keep a critical eye if the guideline suggests a product made by these companies, or an etiology that can be “fixed” by a product from one of these companies. For both sources, it is unclear whether the guideline and textbook were created with the input of an external review committee including patients stakeholder. The omission of such an overview could potentially bias towards a more pharmaceutical company-oriented type of treatment when other treatment modalities can be possible. Another issue is that the two sources might not yet include the most recent development regarding Merkle-cell carcinoma, so there is a possibility that the information taken from these sources is not the most up to date.

On the other hand, these two sources present a good summary of the current state of knowledge, and are commonly used by physicians. I have chosen to use these sources for the introduction of the Wikipedia page, as the introduction sections aims to present a high-level overview of the condition, and my section does not mention treatments, which are arguably the most susceptible to bias.

Hi Stephanie,

Looks good. I don't have any suggestions for improvement.