Hi Grace,

Once an MCC diagnosis is made, a sentinel lymph node biopsy is recommended as a part of the staging work-up needed to determine prognosis and subsequent treatment options. - can you add a reference to this.

you should try to hyperlink key words in your sentences like "sentinel lymph node", and terms that a non-medical person wouldn't understand.

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

Specific planned changes for the "Diagnosis" section of the Merkel Cell Carcinoma article are outlined below.

SECTION 1: Proposed Changes PC 1:Adding 1 sentence in the beginning of the paragraph Diagnosis of MCC begins with a clinical examination of the skin and lymph nodes. Following,

PC 2: Adding 5 words to the end of the first sentence Definitive diagnosis of Merkel cell carcinoma (MCC) requires examination of biopsy tissue to identify its histopathologic features [1,2].

PC 3:: Adding 1-sentence description of Merkel cell carcinoma histopathologic features On light microscopy, MCC shows basaloid tumor nests with neuroendocrine features ("salt and pepper" chromatin, scarce cytoplasm, and brisk mitotic activity) [1,2]

PC 4:: Adding 1-sentence to the very end of the paragraph, clarifying staging-work up using sentinel nodes Once an MCC diagnosis is made, a sentinel lymph node biopsy is recommended as a part of the staging work-up needed to determine prognosis and subsequent treatment options.

PROPOSED PARAGRAPH (WITH CHANGES IMPLEMENTED, IDENTIFIED IN ITALICS) Diagnosis of MCC begins with a clinical examination of the skin and lymph nodes. Following, definitive diagnosis of Merkel cell carcinoma (MCC) requires examination of biopsy tissue to identify its histopathologic features [1,2]. An ideal biopsy specimen is either a punch biopsy or a full-thickness incisional biopsy of the skin including full-thickness dermis and subcutaneous fat. On light microscopy, MCC shows basaloid tumor nests with neuroendocrine features ("salt and pepper" chromatin, scarce cytoplasm, and brisk mitotic activity) [1,2]. In addition to standard examination under light microscopy, immunohistochemistry (IHC) is also generally required to differentiate MCC from other morphologically similar tumors such as small cell lung cancer, the small cell variant of melanoma, various cutaneous leukemic/lymphoid neoplasms, and Ewing's sarcoma. Similarly, most experts recommend longitudinal imaging of the chest, typically a CT scan, to rule out that the possibility that the skin lesion is a skin metastasis of an underlying small cell carcinoma of the lung. Once an MCC diagnosis is made, a sentinel lymph node biopsy is recommended as a part of the staging work-up needed to determine prognosis and subsequent treatment options.

SECTION 2: Rationale for Proposed Change PC 1: To expand on the recommended sequential steps to diagnosis of MCC (which begins with clinical examination). Reference [2] used to support the content.

PC 2: To clarify the purpose of taking the tissue biopsy. Reference [1] and [2] both support this content.

PC 3: To specify the specific histopathologic features of MCCs that differentiates it from the other items on the differential diagnosis list.

PC 4: To complete the sequential diagnostic process currently recommended following diagnosis of MCC to include a staging work-up. Both reference [1] and [2] support this content.

SECTION 3: Identified Controversies / Varied Opinions about Planned Changes Following a literature search of the most up-to-date evidence, no controversy nor varied opinion about the diagnosis/staging work-up of MCCs were identified.

SECTION 4: Critique of Source For the first source, there are several sources of potential biases. Specifically, all three authors report financial and/or non-financial support from healthcare and pharmaceutical industries. As quoted from the article, "Dr. Amaral reports non-financial support from GSK, non-financial support from P3solution, personal fees and non- financial support from Roche, personal fees and non-financial support from BMS, outside the submitted work. Dr. Leiter reports personal fees from Roche, personal fees from Novartis, outside the submitted work. Dr. Garbe reports personal fees from Amgen, grants and personal fees from BMS, grants and personal fees from Novartis, grants and personal fees from Roche, personal fees from MSD, personal fees from Philogen, outside the submitted work. This is a review and therefore there are no issues regarding compliance and ethical standards."

For the second source, all editors, authors, and planners reported no relevant financial relationships with commercial interests. As far as known, this article from the American Academy of Dermatology complied with all necessary compliance and ethical standards.

Diagnosis of MCC begins with a clinical examination of the skin and lymph nodes.^[1] Following, definitive diagnosis of Merkel cell carcinoma (MCC) requires examination of biopsy tissue to identify its histopathologic features.^[1][2] An ideal biopsy specimen is either a punch biopsy or a full-thickness incisional biopsy of the skin including full-thickness dermis and subcutaneous fat. On light microscopy, MCC shows basaloid tumor nests with neuroendocrine features ("salt and pepper" chromatin, scarce cytoplasm, and brisk mitotic activity).^[1][2] In addition to standard examination under light microscopy, immunohistochemistry (IHC) is also generally required to differentiate MCC from other morphologically similar tumors such as small cell lung cancer, the small cell variant of melanoma, various cutaneous leukemic/lymphoid neoplasms, and Ewing's sarcoma. Similarly, most experts recommend longitudinal imaging of the chest, typically a CT scan, to rule out that the possibility that the skin lesion is a skin metastasis of an underlying small cell carcinoma of the lung. Once an MCC diagnosis is made, a sentinel lymph node biopsy is recommended as a part of the staging work-up needed to determine prognosis and subsequent treatment options.^[1][2]