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• 16 April 2024

Structure peer review to make it more robust

• Mario Malički 0

Mario Malički is associate director of the Stanford Program on Research Rigor and Reproducibility (SPORR) and co-editor-in-chief of the Research Integrity and Peer Review journal.

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In February, I received two peer-review reports for a manuscript I’d submitted to a journal. One report contained 3 comments, the other 11. Apart from one point, all the feedback was different. It focused on expanding the discussion and some methodological details — there were no remarks about the study’s objectives, analyses or limitations.

My co-authors and I duly replied, working under two assumptions that are common in scholarly publishing: first, that anything the reviewers didn’t comment on they had found acceptable for publication; second, that they had the expertise to assess all aspects of our manuscript. But, as history has shown, those assumptions are not always accurate (see Lancet 396 , 1056; 2020 ). And through the cracks, inaccurate, sloppy and falsified research can slip.

As co-editor-in-chief of the journal Research Integrity and Peer Review (an open-access journal published by BMC, which is part of Springer Nature), I’m invested in ensuring that the scholarly peer-review system is as trustworthy as possible. And I think that to be robust, peer review needs to be more structured. By that, I mean that journals should provide reviewers with a transparent set of questions to answer that focus on methodological, analytical and interpretative aspects of a paper.

For example, editors might ask peer reviewers to consider whether the methods are described in sufficient detail to allow another researcher to reproduce the work, whether extra statistical analyses are needed, and whether the authors’ interpretation of the results is supported by the data and the study methods. Should a reviewer find anything unsatisfactory, they should provide constructive criticism to the authors. And if reviewers lack the expertise to assess any part of the manuscript, they should be asked to declare this.

Anonymizing peer review makes the process more just

Other aspects of a study, such as novelty, potential impact, language and formatting, should be handled by editors, journal staff or even machines, reducing the workload for reviewers.

The list of questions reviewers will be asked should be published on the journal’s website, allowing authors to prepare their manuscripts with this process in mind. And, as others have argued before, review reports should be published in full. This would allow readers to judge for themselves how a paper was assessed, and would enable researchers to study peer-review practices.

To see how this works in practice, since 2022 I’ve been working with the publisher Elsevier on a pilot study of structured peer review in 23 of its journals, covering the health, life, physical and social sciences. The preliminary results indicate that, when guided by the same questions, reviewers made the same initial recommendation about whether to accept, revise or reject a paper 41% of the time, compared with 31% before these journals implemented structured peer review. Moreover, reviewers’ comments were in agreement about specific parts of a manuscript up to 72% of the time ( M. Malički and B. Mehmani Preprint at bioRxiv https://doi.org/mrdv; 2024 ). In my opinion, reaching such agreement is important for science, which proceeds mainly through consensus.

Stop the peer-review treadmill. I want to get off

I invite editors and publishers to follow in our footsteps and experiment with structured peer reviews. Anyone can trial our template questions (see go.nature.com/4ab2ppc ), or tailor them to suit specific fields or study types. For instance, mathematics journals might also ask whether referees agree with the logic or completeness of a proof. Some journals might ask reviewers if they have checked the raw data or the study code. Publications that employ editors who are less embedded in the research they handle than are academics might need to include questions about a paper’s novelty or impact.

Scientists can also use these questions, either as a checklist when writing papers or when they are reviewing for journals that don’t apply structured peer review.

Some journals — including Proceedings of the National Academy of Sciences , the PLOS family of journals, F1000 journals and some Springer Nature journals — already have their own sets of structured questions for peer reviewers. But, in general, these journals do not disclose the questions they ask, and do not make their questions consistent. This means that core peer-review checks are still not standardized, and reviewers are tasked with different questions when working for different journals.

Some might argue that, because different journals have different thresholds for publication, they should adhere to different standards of quality control. I disagree. Not every study is groundbreaking, but scientists should view quality control of the scientific literature in the same way as quality control in other sectors: as a way to ensure that a product is safe for use by the public. People should be able to see what types of check were done, and when, before an aeroplane was approved as safe for flying. We should apply the same rigour to scientific research.

Ultimately, I hope for a future in which all journals use the same core set of questions for specific study types and make all of their review reports public. I fear that a lack of standard practice in this area is delaying the progress of science.

Nature 628 , 476 (2024)

doi: https://doi.org/10.1038/d41586-024-01101-9

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Competing Interests

M.M. is co-editor-in-chief of the Research Integrity and Peer Review journal that publishes signed peer review reports alongside published articles. He is also the chair of the European Association of Science Editors Peer Review Committee.

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Title: ten years of research on researchgate, a scoping review using google scholar 2008_2017.

Abstract: Objective. To analyse quantitatively the articles published during 2008_2017 about the academic social networking site ResearchGate. Methods. A scoping bibliometric review of documents retrieved using Google Scholar was conducted, limited to publications that contained the word "ResearchGate" in their title and were published from 2008 to 2017. Results. The search yielded 159 documents, once a preliminary list of 386 documents retrieved from Google Scholar was filtered, which eliminated about 60% of the results that were bibliographic citations and not documents. Papers in journals were the most numerous type of documents (n73; 46%), followed by conference papers (n_31; 19.5 %). Contributing eight publications, two Spanish scholars (Delgado Lopez-Cozar and Orduna Malea, who were coauthors in each case) were the most prolific authors writing on this topic during the ten-year period. The keywords most used in the documents were "ResearchGate" and "Altmetrics". The publications were cited frequently since 2014 (more than 90% of the total cites fell in that period), and those with more than one author were the most cited ones. The authors of the documents were mainly librarians and information science professionals, who wrote primarily as co-authors with colleagues from their own institutions, mostly published in English. Conclusions. Interest in ResearchGate has grown since 2015, as evident from the number of articles published and the citations they received. Keywords. Academic social networks, bibliometrics, scholarly communication

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Original research

Health effects of climate change: an overview of systematic reviews, rhea j rocque.

1 Prairie Climate Centre, The University of Winnipeg, Winnipeg, Manitoba, Canada

Caroline Beaudoin

2 Faculty of Medicine, Université Laval, Quebec, QC, Canada

Ruth Ndjaboue

3 VITAM Research Centre for Sustainable Health, Quebec, QC, Canada

Laura Cameron

Louann poirier-bergeron, rose-alice poulin-rheault, catherine fallon.

4 CHUQ Research Centre, Quebec, QC, Canada

Andrea C Tricco

5 Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada

6 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

Holly O Witteman

Associated data.

bmjopen-2020-046333supp001.pdf

bmjopen-2020-046333supp002.pdf

bmjopen-2020-046333supp003.pdf

bmjopen-2020-046333supp004.pdf

bmjopen-2020-046333supp005.pdf

Data sharing not applicable as no datasets generated and/or analysed for this study. All data relevant to the study are included in the article or uploaded as supplementary information. Additional data are not available.

We aimed to develop a systematic synthesis of systematic reviews of health impacts of climate change, by synthesising studies’ characteristics, climate impacts, health outcomes and key findings.

We conducted an overview of systematic reviews of health impacts of climate change. We registered our review in PROSPERO (CRD42019145972). No ethical approval was required since we used secondary data. Additional data are not available.

Data sources

On 22 June 2019, we searched Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Cochrane and Web of Science.

Eligibility criteria

We included systematic reviews that explored at least one health impact of climate change.

Data extraction and synthesis

We organised systematic reviews according to their key characteristics, including geographical regions, year of publication and authors’ affiliations. We mapped the climate effects and health outcomes being studied and synthesised major findings. We used a modified version of A MeaSurement Tool to Assess systematic Reviews-2 (AMSTAR-2) to assess the quality of studies.

We included 94 systematic reviews. Most were published after 2015 and approximately one-fifth contained meta-analyses. Reviews synthesised evidence about five categories of climate impacts; the two most common were meteorological and extreme weather events. Reviews covered 10 health outcome categories; the 3 most common were (1) infectious diseases, (2) mortality and (3) respiratory, cardiovascular or neurological outcomes. Most reviews suggested a deleterious impact of climate change on multiple adverse health outcomes, although the majority also called for more research.

Conclusions

Most systematic reviews suggest that climate change is associated with worse human health. This study provides a comprehensive higher order summary of research on health impacts of climate change. Study limitations include possible missed relevant reviews, no meta-meta-analyses, and no assessment of overlap. Future research could explore the potential explanations between these associations to propose adaptation and mitigation strategies and could include broader sociopsychological health impacts of climate change.

Strengths and limitations of this study

• A strength of this study is that it provides the first broad overview of previous systematic reviews exploring the health impacts of climate change. By targeting systematic reviews, we achieve a higher order summary of findings than what would have been possible by consulting individual original studies.
• By synthesising findings across all included studies and according to the combination of climate impact and health outcome, we offer a clear, detailed and unique summary of the current state of evidence and knowledge gaps about how climate change may influence human health.
• A limitation of this study is that we were unable to access some full texts and therefore some studies were excluded, even though we deemed them potentially relevant after title and abstract inspection.
• Another limitation is that we could not conduct meta-meta-analyses of findings across reviews, due to the heterogeneity of the included systematic reviews and the relatively small proportion of studies reporting meta-analytic findings.
• Finally, the date of the systematic search is a limitation, as we conducted the search in June 2019.

Introduction

The environmental consequences of climate change such as sea-level rise, increasing temperatures, more extreme weather events, increased droughts, flooding and wildfires are impacting human health and lives. 1 2 Previous studies and reviews have documented the multiple health impacts of climate change, including an increase in infectious diseases, respiratory disorders, heat-related morbidity and mortality, undernutrition due to food insecurity, and adverse health outcomes ensuing from increased sociopolitical tension and conflicts. 2–5 Indeed, the most recent Lancet Countdown report, 2 which investigates 43 indicators of the relationship between climate change and human health, arrived at their most worrisome findings since the beginning of their on-going annual work. This report underlines that the health impacts of climate change continue to worsen and are being felt on every continent, although they are having a disproportionate and unequal impact on populations. 2 Authors caution that these health impacts will continue to worsen unless we see an immediate international response to limiting climate change.

To guide future research and action to mitigate and adapt to the health impacts of climate change and its environmental consequences, we need a complete and thorough overview of the research already conducted regarding the health impacts of climate change. Although the number of original studies researching the health impacts of climate change has greatly increased in the recent decade, 2 these do not allow for an in-depth overview of the current literature on the topic. Systematic reviews, on the other hand, allow a higher order overview of the literature. Although previous systematic reviews have been conducted on the health impacts of climate change, these tend to focus on specific climate effects (eg, impact of wildfires on health), 6 7 health impacts (eg, occupational health outcomes), 8 9 countries, 10–12 or are no longer up to date, 13 14 thus limiting our global understanding of what is currently known about the multiple health impacts of climate change across the world.

In this study, we aimed to develop such a complete overview by synthesising systematic reviews of health impacts of climate change. This higher order overview of the literature will allow us to better prepare for the worsening health impacts of climate change, by identifying and describing the diversity and range of health impacts studied, as well as by identifying gaps in previous research. Our research objectives were to synthesise studies’ characteristics such as geographical regions, years of publication, and authors’ affiliations, to map the climate impacts, health outcomes, and combinations of these that have been studied, and to synthesise key findings.

We applied the Cochrane method for overviews of reviews. 15 This method is designed to systematically map the themes of studies on a topic and synthesise findings to achieve a broader overview of the available literature on the topic.

Research questions

Our research questions were the following: (1) What is known about the relationship between climate change and health, as shown in previous systematic reviews? (2) What are the characteristics of these studies? We registered our plan (CRD42019145972 16 ) in PROSPERO, an international prospective register of systematic reviews and followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 17 to report our findings, as a reporting guideline for overviews is still in development. 18

Search strategy and selection criteria

To identify relevant studies, we used a systematic search strategy. There were two inclusion criteria. We included studies in this review if they (1) were systematic reviews of original research and (2) reported at least one health impact as it related (directly or indirectly) to climate change.

We defined a systematic review, based on Cochrane’s definition, as a review of the literature in which one ‘attempts to identify, appraise and synthesize all the empirical evidence that meets pre-specified eligibility criteria to answer a specific research question [by] us[ing] explicit, systematic methods that are selected with a view aimed at minimizing bias, to produce more reliable findings to inform decision making’. 19 We included systematic reviews of original research, with or without meta-analyses. We excluded narrative reviews, non-systematic literature reviews and systematic reviews of materials that were not original research (eg, systematic reviews of guidelines.)

We based our definition of health impacts on the WHO’s definition of health as, ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. 20 Therefore, health impacts included, among others, morbidity, mortality, new conditions, worsening/improving conditions, injuries and psychological well-being. Included studies could refer to climate change or global warming directly or indirectly, for instance, by synthesising the direct or indirect health effects of temperature rises or of natural conditions/disasters made more likely by climate change (eg, floods, wildfires, temperature variability, droughts.) Although climate change and global warming are not equivalent terms, in an effort to avoid missing relevant literature, we included studies using either term. We included systematic reviews whose main focus was not the health impacts of climate change, providing they reported at least one result regarding health effects related to climate change (or consequences of climate change.) We excluded studies if they did not report at least one health effect of climate change. For instance, we excluded studies which reported on existing measures of health impacts of climate change (and not the health impact itself) and studies which reported on certain health impacts without a mention of climate change, global warming or environmental consequences made more likely by climate change.

On 22 June 2019, we retrieved systematic reviews regarding the health effects of climate change by searching from inception the electronic databases Medline, CINAHL, Embase, Cochrane, Web of Science using a structured search (see online supplemental appendix 1 for final search strategy developed by a librarian.) We did not apply language restrictions. After removing duplicates, we imported references into Covidence. 21

Supplementary data

Screening process and data extraction.

To select studies, two trained analysts first screened independently titles and abstracts to eliminate articles that did not meet our inclusion criteria. Next, the two analysts independently screened the full text of each article. A senior analyst resolved any conflict or disagreement.

Next, we decided on key information that needed to be extracted from studies. We extracted the first author’s name, year of publication, number of studies included, time frame (in years) of the studies included in the article, first author’s institution’s country affiliation, whether the systematic review included a meta-analysis, geographical focus, population focus, the climate impact(s) and the health outcome(s) as well as the main findings and limitations of each systematic review.

Two or more trained analysts (RR, CB, RN, LC, LPB, RAPR) independently extracted data, using Covidence and spreadsheet software (Google Sheets). An additional trained analyst from the group or senior research team member resolved disagreements between individual judgments.

Coding and data mapping

To summarise findings from previous reviews, we first mapped articles according to climate impacts and health outcomes. To develop the categories of climate impacts and health outcomes, two researchers (RR and LC) consulted the titles and abstracts of each article. We started by identifying categories directly based on our data and finalised our categories by consulting previous conceptual frameworks of climate impacts and health outcomes. 1 22 23 The same two researchers independently coded each article according to their climate impact and health outcome. We then compared coding and resolved disagreements through discussion.

Next, using spreadsheet software, we created a matrix to map articles according to their combination of climate impacts and health outcomes. Each health outcome occupied one row, whereas climate impacts each occupied one column. We placed each article in the matrix according to the combination(s) of their climate impact(s) and health outcome(s). For instance, if we coded an article as ‘extreme weather’ for climate and ‘mental health’ for health impact, we noted the reference of this article in the cell at the intersection of these two codes. We calculated frequencies for each cell to identify frequent combinations and gaps in literature. Because one study could investigate more than one climate impact and health outcome, the frequency counts for each category could exceed the number of studies included in this review.

Finally, we re-read the Results and Discussion sections of each article to summarise findings of the studies. We first wrote an individual summary for each study, then we collated the summaries of all studies exploring the same combination of categories to develop an overall summary of findings for each combination of categories.

Quality assessment

We used a modified version of AMSTAR-2 to assess the quality of the included systematic reviews ( online supplemental appendix 2 ). The purpose of this assessment was to evaluate the quality of the included studies as a whole to get a sense of the overall quality of evidence in this field. Therefore, individual quality scores were not compiled for each article, but scores were aggregated according to items. Since AMSTAR-2 was developed for syntheses of systematic reviews of randomised controlled trials, working with a team member with expertise in knowledge synthesis (AT), we adapted it to suit a research context that is not amenable to randomised controlled trials. For instance, we changed assessing and accounting for risk of bias in studies’ included randomised controlled trials to assessing and accounting for limitations in studies’ included articles. Complete modifications are presented in online supplemental appendix 2 .

Patient and public involvement

Patients and members of the public were not involved in this study.

Articles identified

As shown in the PRISMA diagram in figure 1 , from an initial set of 2619 references, we retained 94 for inclusion. More precisely, following screening of titles and abstracts, 146 studies remained for full-text inspection. During full-text inspection, we excluded 52 studies, as they did not report a direct health effect of climate change (n=17), did not relate to climate change (n=15), were not systematic reviews (n=10), or we could not retrieve the full text (n=10).

The flow chart for included articles in this review.

Study descriptions

A detailed table of all articles and their characteristics can be found in online supplemental appendix 3 . Publication years ranged from 2007 to 2019 (year of data extraction), with the great majority of included articles (n=69; 73%) published since 2015 ( figure 2 ). A median of 30 studies had been included in the systematic reviews (mean=60; SD=49; range 7–722). Approximately one-fifth of the systematic reviews included meta-analyses of their included studies (n=18; 19%). The majority of included systematic reviews’ first authors had affiliations in high-income countries, with the largest representations by continent in Europe (n=30) and Australia (n=24) ( figure 3 ). Countries of origin by continents include (from highest to lowest frequency, then by alphabetical order): Europe (30); UK (9), Germany (6), Italy (4), Sweden (4), Denmark (2), France (2), Georgia (1), Greece (1) and Finland (1); Australia (24); Asia (21); China (11), Iran (4), India (1), Jordan (1), Korea (1), Nepal (1), Philippines (1), Taiwan (1); North America (16); USA (15), Canada (1); Africa (2); Ethiopia (1), Ghana (1), and South America (1); Brazil (1).

Number of included systematic reviews by year of publication.

Number of publications according to geographical affiliation of the first author.

Regarding the geographical focus of systematic reviews, most of the included studies (n=68; 72%) had a global focus or no specified geographical limitations and therefore included studies published anywhere in the world. The remaining systematic reviews either targeted certain countries (n=12) (1 for each Australia, Germany, Iran, India, Ethiopia, Malaysia, Nepal, New Zealand and 2 reviews focused on China and the USA), continents (n=5) (3 focused on Europe and 2 on Asia), or regions according to geographical location (n=6) (1 focused on Sub-Saharan Africa, 1 on Eastern Mediterranean countries, 1 on Tropical countries, and 3 focused on the Arctic), or according to the country’s level of income (n=3) (2 on low to middle income countries, 1 on high income countries).

Regarding specific populations of interest, most of the systematic reviews did not define a specific population of interest (n=69; 73%). For the studies that specified a population of interest (n=25; 26.6%), the most frequent populations were children (n=7) and workers (n=6), followed by vulnerable or susceptible populations more generally (n=4), the elderly (n=3), pregnant people (n=2), people with disabilities or chronic illnesses (n=2) and rural populations (n=1).

We assessed studies for quality according to our revised AMSTAR-2. Complete scores for each article and each item are available in online supplemental appendix 4 . Out of 94 systematic reviews, the most commonly fully satisfied criterion was #1 (Population, Intervention, Comparator, Outcome (PICO) components) with 81/94 (86%) of included systematic reviews fully satisfying this criterion. The next most commonly satisfied criteria were #16 (potential sources of conflict of interest reported) (78/94=83% fully), #13 (account for limitations in individual studies) (70/94=75% fully and 2/94=2% partially), #7 (explain both inclusion and exclusion criteria) (64/94=68% fully and 19/94=20% partially), #8 (description of included studies in adequate detail) (36/94=38% fully and 41/94=44% partially), and #4 (use of a comprehensive literature search strategy) (0/94=0% fully and 80/94=85% partially). For criteria #11, #12, and #15, which only applied to reviews including meta-analyses, 17/18 (94%) fully satisfied criterion #11 (use of an appropriate methods for statistical combination of results), 12/18 (67%) fully satisfied criterion #12 (assessment of the potential impact of Risk of Bias (RoB) in individual studies) (1/18=6% partially), and 11/18 (61%) fully satisfied criterion #15 (an adequate investigation of publication bias, small study bias).

Climate impacts and health outcomes

Regarding climate impacts, we identified 5 mutually exclusive categories, with 13 publications targeting more than one category of climate impacts: (1) meteorological (n=71 papers) (eg, temperature, heat waves, humidity, precipitation, sunlight, wind, air pressure), (2) extreme weather (n=24) (eg, water-related, floods, cyclones, hurricanes, drought), (3) air quality (n=7) (eg, air pollution and wildfire smoke exposure), (4) general (n=5), and (5) other (n=3). Although heat waves could be considered an extreme weather event, papers investigating heat waves’ impact on health were classified in the meteorological impact category, since some of these studies treated them with high temperature. ‘General’ climate impacts included articles that did not specify climate change impacts but stated general climate change as their focus. ‘Other’ climate impacts included studies investigating other effects indirectly related to climate change (eg, impact of environmental contaminants) or general environmental risk factors (eg, environmental hazards, sanitation and access to clean water.)

We identified 10 categories to describe the health outcomes studied by the systematic reviews, and 29 publications targeted more than one category of health outcomes: (1) infectious diseases (n=41 papers) (vector borne, food borne and water borne), (2) mortality (n=32), (3) respiratory, cardiovascular and neurological (n=23), (4) healthcare systems (n=16), 5) mental health (n=13), (6) pregnancy and birth (n=11), 7) nutritional (n=9), (8) skin diseases and allergies (n=8), (9) occupational health and injuries (n=6) and (10) other health outcomes (n=17) (eg, sleep, arthritis, disability-adjusted life years, non-occupational injuries, etc)

Figure 4 depicts the combinations of climate impact and health outcome for each study, with online supplemental appendix 5 offering further details. The five most common combinations are studies investigating the (1) meteorological impacts on infectious diseases (n=35), (2) mortality (n=24) and (3) respiratory, cardiovascular and neurological outcomes (n=17), (4) extreme weather events’ impacts on infectious diseases (n=14), and (5) meteorological impacts on health systems (n=11).

Summary of the combination of climate impact and health outcome (frequencies). The total frequency for one category of health outcome could exceed the number of publications included in this health outcome, since one publication could explore the health impact according to more than one climate factor (eg, one publication could explore both the impact of extreme weather events and temperature on mental health).

For studies investigating meteorological impacts on health, the three most common health outcomes studied were impacts on (1) infectious diseases (n=35), (2) mortality (n=24) and (3) respiratory, cardiovascular and neurological outcomes (n=17). Extreme weather event studies most commonly reported health outcomes related to (1) infectious diseases (n=14), (2) mental health outcomes (n=9) and (3) nutritional outcomes (n=6) and other health outcomes (eg, injuries, sleep) (n=6). Studies focused on the impact of air quality were less frequent and explored mostly health outcomes linked to (1) respiratory, cardiovascular and neurological outcomes (n=6), (2) mortality (n=5) and (3) pregnancy and birth outcomes (n=3).

Summary of findings

Most reviews suggest a deleterious impact of climate change on multiple adverse health outcomes, with some associations being explored and/or supported with consistent findings more often than others. Some reviews also report conflicting findings or an absence of association between the climate impact and health outcome studied (see table 1 for a detailed summary of findings according to health outcomes).

Summary of findings from systematic reviews according to health outcome and climate impact

Reviews that covered multiple climate impacts are listed in each relevant category.

Notable findings of health outcomes according to climate impact include the following. For meteorological factors (n=71), temperature and humidity are the variables most often studied and report the most consistent associations with infectious diseases and respiratory, cardiovascular, and neurological outcomes. Temperature is also consistently associated with mortality and healthcare service use. Some associations are less frequently studied, but remain consistent, including the association between some meteorological factors (eg, temperature and heat) and some adverse mental health outcomes (eg, hospital admissions for mental health reasons, suicide, exacerbation of previous mental health conditions), and the association between heat and adverse occupational outcomes and some adverse birth outcomes. Temperature is also associated with adverse nutritional outcomes (likely via crop production and food insecurity) and temperature and humidity are associated with some skin diseases and allergies. Some health outcomes are less frequently studied, but studies suggest an association between temperature and diabetes, impaired sleep, cataracts, heat stress, heat exhaustion and renal diseases.

Extreme weather events (n=24) are consistently associated with mortality, some mental health outcomes (eg, distress, anxiety, depression) and adverse nutritional outcomes (likely via crop production and food insecurity). Some associations are explored less frequently, but these studies suggest an association between drought and respiratory and cardiovascular outcomes (likely via air quality), between extreme weather events and an increased use of healthcare services and some adverse birth outcomes (likely due to indirect causes, such as experiencing stress). Some health outcomes are less frequently studied, but studies suggest an association between extreme weather events and injuries, impaired sleep, oesophageal cancer and exacerbation of chronic illnesses. There are limited and conflicting findings for the association between extreme weather events and infectious diseases, as well as for certain mental health outcomes (eg, suicide and substance abuse). At times, different types of extreme weather events (eg, drought vs flood) led to conflicting findings for some health outcomes (eg, mental health outcomes, infectious diseases), but for other health outcomes, the association was consistent independently of the extreme weather event studied (eg, mortality, healthcare service use and nutritional outcomes).

The impact of air quality on health (n=7) was less frequently studied, but the few studies exploring this association report consistent findings regarding an association with respiratory-specific mortality, adverse respiratory outcomes and an increase in healthcare service use. There is limited evidence regarding the association between air quality and cardiovascular outcomes, limited and inconsistent evidence between wildfire smoke exposure and adverse birth outcomes, and no association is found between exposure to wildfire smoke and increase in use of health services for mental health reasons. Only one review explored the impact of wildfire smoke exposure on ophthalmic outcomes, and it suggests that it may be associated with eye irritation and cataracts.

Reviews which stated climate change as their general focus and did not specify the climate impact(s) under study were less frequent (n=5), but they suggest an association between climate change and pollen allergies in Europe, increased use of healthcare services, obesity, skin diseases and allergies and an association with disability-adjusted life years. Reviews investigating the impact of other climate-related factors (n=3) show inconsistent findings concerning the association between environmental pollutant and adverse birth outcomes, and two reviews suggest an association between environmental risk factors and pollutants and childhood stunting and occupational diseases.

Most reviews concluded by calling for more research, noting the limitations observed among the studies included in their reviews, as well as limitations in their reviews themselves. These limitations included, among others, some systematic reviews having a small number of publications, 24 25 language restrictions such as including only papers in English, 26 27 arriving at conflicting evidence, 28 difficulty concluding a strong association due to the heterogeneity in methods and measurements or the limited equipment and access to quality data in certain contexts, 24 29–31 and most studies included were conducted in high-income countries. 32 33

Previous authors also discussed the important challenge related to exploring the relationship between climate change and health. Not only is it difficult to explore the potential causal relationship between climate change and health, mostly due to methodological challenges, but there are also a wide variety of complex causal factors that may interact to determine health outcomes. Therefore, the possible causal mechanisms underlying these associations were at times still unknown or uncertain and the impacts of some climate factors were different according to geographical location and specificities of the context. Nonetheless, some reviews offered potential explanations for the climate-health association, with the climate factor at times, having a direct impact on health (eg, flooding causing injuries, heat causing dehydration) and in other cases, having an indirect impact (eg, flooding causing stress which in turn may cause adverse birth outcomes, heat causing difficulty concentrating leading to occupational injuries.)

Principal results

In this overview of systematic reviews, we aimed to develop a synthesis of systematic reviews of health impacts of climate change by mapping the characteristics and findings of studies exploring the relationship between climate change and health. We identified four key findings.

First, meteorological impacts, mostly related to temperature and humidity, were the most common impacts studied by included publications, which aligns with findings from a previous scoping review on the health impacts of climate change in the Philippines. 10 Indeed, meteorological factors’ impact on all health outcomes identified in this review are explored, although some health outcomes are more rarely explored (eg, mental health and nutritional outcomes). Although this may not be surprising given that a key implication of climate change is the long-term meteorological impact of temperature rise, this finding suggests we also need to undertake research focused on other climate impacts on health, including potential direct and indirect effects of temperature rise, such as the impact of droughts and wildfire smoke. This will allow us to better prepare for the health crises that arise from these ever-increasing climate-related impacts. For instance, the impacts of extreme weather events and air quality on certain health outcomes are not explored (eg, skin diseases and allergies, occupational health) or only rarely explored (eg, pregnancy outcomes).

Second, systematic reviews primarily focus on physical health outcomes, such as infectious diseases, mortality, and respiratory, cardiovascular and neurological outcomes, which also aligns with the country-specific previous scoping review. 10 Regarding mortality, we support Campbell and colleagues’ 34 suggestion that we should expand our focus to include other types of health outcomes. This will provide better support for mitigation policies and allow us to adapt to the full range of threats of climate change.

Moreover, it is unclear whether the distribution of frequencies of health outcomes reflects the actual burden of health impacts of climate change. The most commonly studied health outcomes do not necessarily reflect the definition of health presented by the WHO as, ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. 20 This suggests that future studies should investigate in greater depth the impacts of climate change on mental and broader social well-being. Indeed, some reviews suggested that climate change impacts psychological and social well-being, via broader consequences, such as political instability, health system capacity, migration, and crime, 3 4 35 36 thus illustrating how our personal health is determined not only by biological and environmental factors but also by social and health systems. The importance of expanding our scope of health in this field is also recognised in the most recent Lancet report, which states that future reports will include a new mental health indicator. 2

Interestingly, the reviews that explored the mental health impacts of climate change were focused mostly on the direct and immediate impacts of experiencing extreme weather events. However, psychologists are also warning about the long-term indirect mental health impacts of climate change, which are becoming more prevalent for children and adults alike (eg, eco-anxiety, climate depression). 37 38 Even people who do not experience direct climate impacts, such as extreme weather events, report experiencing distressing emotions when thinking of the destruction of our environment or when worrying about one’s uncertain future and the lack of actions being taken. To foster emotional resilience in the face of climate change, these mental health impacts of climate change need to be further explored. Humanity’s ability to adapt to and mitigate climate change ultimately depends on our emotional capacity to face this threat.

Third, there is a notable geographical difference in the country affiliations of first authors, with three quarters of systematic reviews having been led by first authors affiliated to institutions in Europe, Australia, or North America, which aligns with the findings of the most recent Lancet report. 2 While perhaps unsurprising given the inequalities in research funding and institutions concentrated in Western countries, this is of critical importance given the significant health impacts that are currently faced (and will remain) in other parts of the world. Research funding organisations should seek to provide more resources to authors in low-income to middle-income countries to ensure their expertise and perspectives are better represented in the literature.

Fourth, overall, most reviews suggest an association between climate change and the deterioration of health in various ways, illustrating the interdependence of our health and well-being with the well-being of our environment. This interdependence may be direct (eg, heat’s impact on dehydration and exhaustion) or indirect (eg, via behaviour change due to heat.) The most frequently explored and consistently supported associations include an association between temperature and humidity with infectious diseases, mortality and adverse respiratory, cardiovascular and neurological outcomes. Other less frequently studied but consistent associations include associations between climate impacts and increased use of healthcare services, some adverse mental health outcomes, adverse nutritional outcomes and adverse occupational health outcomes. These associations support key findings of the most recent Lancet report, in which authors report, among others, increasing heat exposure being associated with increasing morbidities and mortality, climate change leading to food insecurity and undernutrition, and to an increase in infectious disease transmission. 2

That said, a number of reviews included in this study reported limited, conflicting and/or an absence of evidence regarding the association between the climate impact and health outcome. For instance, there was conflicting or limited evidence concerning the association between extreme weather events and infectious diseases, cardiorespiratory outcomes and some mental health outcomes and the association between air quality and cardiovascular-specific mortality and adverse birth outcomes. These conflicting and limited findings highlight the need for further research. These associations are complex and there exist important methodological challenges inherent to exploring the causal relationship between climate change and health outcomes. This relationship may at times be indirect and likely determined by multiple interacting factors.

The climate-health link has been the target of more research in recent years and it is also receiving increasing attention from the public and in both public health and climate communication literature. 2 39–41 However, the health framing of climate change information is still underused in climate communications, and researchers suggest we should be doing more to make the link between human health and climate change more explicit to increase engagement with the climate crisis. 2 41–43 The health framing of climate communication also has implications for healthcare professionals 44 and policy-makers, as these actors could play a key part in climate communication, adaptation and mitigation. 41 42 45 These key stakeholders’ perspectives on the climate-health link, as well as their perceived role in climate adaptation and mitigation could be explored, 46 since research suggests that health professionals are important voices in climate communications 44 and especially since, ultimately, these adverse health outcomes will engender pressure on and cost to our health systems and health workers.

Strengths and limitations

To the best of our knowledge, the current study provides the first broad overview of previous systematic reviews exploring the health impacts of climate change. Our review has three main strengths. First, by targeting systematic reviews, we achieve a higher order summary of findings than what would have been possible by consulting individual original studies. Second, by synthesising findings across all included studies and according to the combination of climate impact and health outcome, we offer a clear, detailed and unique summary of the current state of evidence and knowledge gaps about how climate change may influence human health. This summary may be of use to researchers, policy-makers and communities. Third, we included studies published in all languages about any climate impact and any health outcome. In doing so, we provide a comprehensive and robust overview.

Our work has four main limitations. First, we were unable to access some full texts and therefore some studies were excluded, even though we deemed them potentially relevant after title and abstract inspection. Other potentially relevant systematic reviews may be missing due to unseen flaws in our systematic search. Second, due to the heterogeneity of the included systematic reviews and the relatively small proportion of studies reporting meta-analytic findings, we could not conduct meta-meta-analyses of findings across reviews. Future research is needed to quantify the climate and health links described in this review, as well as to investigate the causal relationship and other interacting factors. Third, due to limited resources, we did not assess overlap between the included reviews concerning the studies they included. Frequencies and findings should be interpreted with potential overlap in mind. Fourth, we conducted the systematic search of the literature in June 2019, and it is therefore likely that some recent systematic reviews are not included in this study.

Overall, most systematic reviews of the health impacts of climate change suggest an association between climate change and the deterioration of health in multiple ways, generally in the direction that climate change is associated with adverse human health outcomes. This is worrisome since these outcomes are predicted to rise in the near future, due to the rise in temperature and increase in climate-change-related events such as extreme weather events and worsened air quality. Most studies included in this review focused on meteorological impacts of climate change on adverse physical health outcomes. Future studies could fill knowledge gaps by exploring other climate-related impacts and broader psychosocial health outcomes. Moreover, studies on health impacts of climate change have mostly been conducted by first authors affiliated with institutions in high-income countries. This inequity needs to be addressed, considering that the impacts of climate change are and will continue to predominantly impact lower income countries. Finally, although most reviews also recommend more research to better understand and quantify these associations, to adapt to and mitigate climate change’s impacts on health, it will also be important to unpack the ‘what, how, and where’ of these effects. Health effects of climate change are unlikely to be distributed equally or randomly through populations. It will be important to mitigate the changing climate’s potential to exacerbate health inequities.

Supplementary Material

Acknowledgments.

The authors gratefully acknowledge the contributions of Selma Chipenda Dansokho, as research associate, and Thierry Provencher, as research assistant, to this project, and of Frederic Bergeron, for assistance with search strategy, screening and selection of articles for the systematic review.

Twitter: @RutNdjab, @ATricco, @hwitteman

Contributors: RN, CF, ACT, HOW contributed to the design of the study. CB, RN, LPB, RAPR and HOW contributed to the systematic search of the literature and selection of studies. RR, HOW, LC conducted data analysis and interpretation. RR and HOW drafted the first version of the article with early revision by CB, LC and RN. All authors critically revised the article and approved the final version for submission for publication. RR and HOW had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Funding: This study was funded by the Canadian Institutes of Health Research (CIHR) FDN-148426. The CIHR had no role in determining the study design, the plans for data collection or analysis, the decision to publish, nor the preparation of this manuscript. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. HOW is funded by a Tier 2 Canada Research Chair in Human-Centred Digital Health.

Competing interests: None declared.

Provenance and peer review: Not commissioned; externally peer reviewed.

Supplemental material: This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Data availability statement

Ethics statements, patient consent for publication.

Not required.

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• Critical Reviews

How to Write an Article Review (With Examples)

Last Updated: April 24, 2024 Fact Checked

Preparing to Write Your Review

Writing the article review, sample article reviews, expert q&a.

This article was co-authored by Jake Adams . Jake Adams is an academic tutor and the owner of Simplifi EDU, a Santa Monica, California based online tutoring business offering learning resources and online tutors for academic subjects K-College, SAT & ACT prep, and college admissions applications. With over 14 years of professional tutoring experience, Jake is dedicated to providing his clients the very best online tutoring experience and access to a network of excellent undergraduate and graduate-level tutors from top colleges all over the nation. Jake holds a BS in International Business and Marketing from Pepperdine University. There are 12 references cited in this article, which can be found at the bottom of the page. This article has been fact-checked, ensuring the accuracy of any cited facts and confirming the authority of its sources. This article has been viewed 3,094,896 times.

An article review is both a summary and an evaluation of another writer's article. Teachers often assign article reviews to introduce students to the work of experts in the field. Experts also are often asked to review the work of other professionals. Understanding the main points and arguments of the article is essential for an accurate summation. Logical evaluation of the article's main theme, supporting arguments, and implications for further research is an important element of a review . Here are a few guidelines for writing an article review.

Education specialist Alexander Peterman recommends: "In the case of a review, your objective should be to reflect on the effectiveness of what has already been written, rather than writing to inform your audience about a subject."

Article Review 101

• Read the article very closely, and then take time to reflect on your evaluation. Consider whether the article effectively achieves what it set out to.
• Write out a full article review by completing your intro, summary, evaluation, and conclusion. Don't forget to add a title, too!
• Proofread your review for mistakes (like grammar and usage), while also cutting down on needless information.

• Article reviews present more than just an opinion. You will engage with the text to create a response to the scholarly writer's ideas. You will respond to and use ideas, theories, and research from your studies. Your critique of the article will be based on proof and your own thoughtful reasoning.
• An article review only responds to the author's research. It typically does not provide any new research. However, if you are correcting misleading or otherwise incorrect points, some new data may be presented.
• An article review both summarizes and evaluates the article.

• Summarize the article. Focus on the important points, claims, and information.
• Discuss the positive aspects of the article. Think about what the author does well, good points she makes, and insightful observations.
• Identify contradictions, gaps, and inconsistencies in the text. Determine if there is enough data or research included to support the author's claims. Find any unanswered questions left in the article.

• Make note of words or issues you don't understand and questions you have.
• Look up terms or concepts you are unfamiliar with, so you can fully understand the article. Read about concepts in-depth to make sure you understand their full context.

• Pay careful attention to the meaning of the article. Make sure you fully understand the article. The only way to write a good article review is to understand the article.

• With either method, make an outline of the main points made in the article and the supporting research or arguments. It is strictly a restatement of the main points of the article and does not include your opinions.
• After putting the article in your own words, decide which parts of the article you want to discuss in your review. You can focus on the theoretical approach, the content, the presentation or interpretation of evidence, or the style. You will always discuss the main issues of the article, but you can sometimes also focus on certain aspects. This comes in handy if you want to focus the review towards the content of a course.
• Review the summary outline to eliminate unnecessary items. Erase or cross out the less important arguments or supplemental information. Your revised summary can serve as the basis for the summary you provide at the beginning of your review.

• What does the article set out to do?
• What is the theoretical framework or assumptions?
• Are the central concepts clearly defined?
• How adequate is the evidence?
• How does the article fit into the literature and field?
• Does it advance the knowledge of the subject?
• How clear is the author's writing? Don't: include superficial opinions or your personal reaction. Do: pay attention to your biases, so you can overcome them.

• For example, in MLA , a citation may look like: Duvall, John N. "The (Super)Marketplace of Images: Television as Unmediated Mediation in DeLillo's White Noise ." Arizona Quarterly 50.3 (1994): 127-53. Print. [9] X Trustworthy Source Purdue Online Writing Lab Trusted resource for writing and citation guidelines Go to source

• For example: The article, "Condom use will increase the spread of AIDS," was written by Anthony Zimmerman, a Catholic priest.

• Your introduction should only be 10-25% of your review.
• End the introduction with your thesis. Your thesis should address the above issues. For example: Although the author has some good points, his article is biased and contains some misinterpretation of data from others’ analysis of the effectiveness of the condom.

• Use direct quotes from the author sparingly.
• Review the summary you have written. Read over your summary many times to ensure that your words are an accurate description of the author's article.

• Support your critique with evidence from the article or other texts.
• The summary portion is very important for your critique. You must make the author's argument clear in the summary section for your evaluation to make sense.
• Remember, this is not where you say if you liked the article or not. You are assessing the significance and relevance of the article.
• Use a topic sentence and supportive arguments for each opinion. For example, you might address a particular strength in the first sentence of the opinion section, followed by several sentences elaborating on the significance of the point.

• This should only be about 10% of your overall essay.
• For example: This critical review has evaluated the article "Condom use will increase the spread of AIDS" by Anthony Zimmerman. The arguments in the article show the presence of bias, prejudice, argumentative writing without supporting details, and misinformation. These points weaken the author’s arguments and reduce his credibility.

• Make sure you have identified and discussed the 3-4 key issues in the article.

You Might Also Like

• ↑ https://libguides.cmich.edu/writinghelp/articlereview
• ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548566/
• ↑ Jake Adams. Academic Tutor & Test Prep Specialist. Expert Interview. 24 July 2020.
• ↑ https://guides.library.queensu.ca/introduction-research/writing/critical
• ↑ https://www.iup.edu/writingcenter/writing-resources/organization-and-structure/creating-an-outline.html
• ↑ https://writing.umn.edu/sws/assets/pdf/quicktips/titles.pdf
• ↑ https://owl.purdue.edu/owl/research_and_citation/mla_style/mla_formatting_and_style_guide/mla_works_cited_periodicals.html
• ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548565/
• ↑ https://writingcenter.uconn.edu/wp-content/uploads/sites/593/2014/06/How_to_Summarize_a_Research_Article1.pdf
• ↑ https://www.uis.edu/learning-hub/writing-resources/handouts/learning-hub/how-to-review-a-journal-article
• ↑ https://writingcenter.unc.edu/tips-and-tools/editing-and-proofreading/

About This Article

If you have to write an article review, read through the original article closely, taking notes and highlighting important sections as you read. Next, rewrite the article in your own words, either in a long paragraph or as an outline. Open your article review by citing the article, then write an introduction which states the article’s thesis. Next, summarize the article, followed by your opinion about whether the article was clear, thorough, and useful. Finish with a paragraph that summarizes the main points of the article and your opinions. To learn more about what to include in your personal critique of the article, keep reading the article! Did this summary help you? Yes No

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ResearchGate and Academia.edu as networked socio-technical systems for scholarly communication: a literature review

2018, Research in Learning Technology

ResearchGate and Academia.edu have been increasingly acknowledged as the most popular academic social network sites (ASNS) for scholarly communication. Along with their benefits for supporting communication and knowledge sharing within academic communities, concerns over quality and credibility remain a pertinent issue. In terms of research investigation, ASNS have attracted strong attention for new scholarly practice and their potential for building, maintaining and enhancing reputation. However, a thorough understanding is still lacking of how these sites operate as networked socio-technical systems reshaping scholarly practices and academic identity. This article analyses 39 empirical studies published in peer-reviewed journals with a specific focus on ResearchGate and Academia.edu. The aim is to describe the status of the research and to identify gaps and priorities in the areas of scholarly networked learning and shared knowledge. Results show that the number of studies focusing on ResearchGate was more than double those dedicated to Academia.edu. While both sites have attracted attention in the library and information sciences as deployments for reputation building and alternative ranking systems, such as ResearchGate metrics, there is a dearth of research investigating practices and new modes of communication in the light of a networked participatory approach to scholarship. Most of the studies analysed focused on the general uptake or impact assessment of alternative metrics, while very few investigated individual and collective scholarly practices. This study points to the need for specific research on open and distributed learning achieved in ASNS according to a networked learning perspective.

Related Papers

Italian Journal of Educational Technology

Stefania Manca

Academic social network sites (ASNS) like ResearchGate and Academia.edu are digital platforms for information sharing and systems for open dissemination of scholarly practices that are gaining momentum among researchers of multiple disciplines. Although ASNS are increasingly transforming scholarly practices and academic identity, a unifying theoretical approach that analyses these platforms at both a systemic/infrastructural and at a personal/individual level is missing. Moreover, despite there is an increasing amount of studies on social media benefits for scholarly networking and knowledge sharing, very few studies have investigated specific benefits of ResearchGate and Academia.edu for scholars' professional development according to a networked learning perspective. This study focuses on academic social network sites as networked socio-technical systems and adopts a three-level analysis related to ASNS as platforms for digital scholarship and scholarly communication. The approach comprises: 1) a macro-level, which constitutes the socioeconomic layer; 2) a meso-level, which comprises the techno-cultural layer; and 3) a micro-level, which constitutes the networked-scholar layer. The study reports on investigations into the technological features provided by ResearchGate and Academia.edu for networked learning that are based on the multilevel approach. The final aim is to exemplify how these digital services are socio-technical systems that support scholars' knowledge sharing and professional learning.

Kayvan Kousha

Wan Muhammad Azreen

Academic social network sites Academia.edu and ResearchGate and reference sharing sites Mendeley, Bibsonomy, Zotero, and CiteULike give scholars the ability to publicise their research outputs and connect to each other. With millions of users, these are a significant addition to the scholarly communication and academic information seeking eco-structure. There is thus a need to understand the role that they play and the changes, if any, that they can make to the dynamics of academic careers. This article investigates attributes of philosophy scholars on Academia.edu, introducing a median-based time-normalising method to adjust for time delays in joining the site. In comparison to students, faculty tend to attract more profile views but female philosophers did not attract more profile views than did males, suggesting that academic capital drives philosophy uses of the site more than friendship and networking. Secondary analyses of law, history and computer science confirmed the faculty advantage (in terms of higher profile views) except for females in law and females in computer science. It also found a female advantage for both faculty and students in law and computer science as well as for history students. Hence, Academia.edu overall seems to reflect a hybrid of scholarly norms (the faculty advantage) and a female advantage that is suggestive of general social networking norms. Finally, traditional bibliometric measures did not correlate with any Academia.edu metrics for philosophers, perhaps because more senior academics use the site less extensively or because of the range informal scholarly activities that cannot be measured by bibliometric methods.

The increasing popularity of academic social networking sites (ASNSs) requires studies on the usage of ASNSs among scholars, and evaluations of the effectiveness of these ASNSs. However, it is unclear whether current ASNSs have fulfilled their design goal, as scholars' actual online interactions on these platforms remain unexplored. To fill the gap, this paper presents a study based on data collected from ResearchGate. Adopting a mixed-method design by conducting qualitative content analysis and statistical analysis on 1128 posts collected from ResearchGate Q&A, we examine how scholars exchange information and resources, and how their practices vary across three distinct disciplines: Library and Information Services, History of Art, and Astrophysics.

David Nicholas , Eti Herman , Dj Clark

Employing a newly developed conceptual framework of the tasks and activities that comprise today's digital scholarly undertaking and their potentially reputation building, maintaining and enhancing components, the efforts of ResearchGate in supporting scholars' reputation building endeavours were put under the microscope. Not unexpectedly, RG performs well in regard to basic research activities. Clearly, too, with ten metrics at its disposal, RG is in a league of its own when it comes to monitoring individual research reputation. Where RG falls down is regarding scholarly activities that do not concern pure research and so especially teaching. Its claim to have created a new way of measuring reputation is only partially true because if it wants to do so genuinely then it needs to extend the range of scholarly activities covered. RG also falls short in informing members as to the nature and changes to its service and of embracing new actors, such as citizen scientists and amateur experts.

David Nicholas , Stéphanie Pouchot , Blanca Bravo , Chérifa Boukacem

Frontiers in Digital Humanities

Dr. Katy Jordan

Marcos Benincasa

Academic social network sites Academia.edu and ResearchGate, and reference sharing sites Mendeley, Bibsonomy, Zotero, and CiteULike, give scholars the ability to publicize their research outputs and connect with each other. With millions of users, these are a significant addition to the scholarly communication and academic information-seeking eco-structure. There is thus a need to understand the role that they play and the changes, if any, that they can make to the dynamics of academic careers. This article investigates attributes of philosophy scholars on Academia.edu, introducing a median-based, time-normalizing method to adjust for time delays in joining the site. In comparison to students, faculty tend to attract more profile views but female philosophers did not attract more profile views than did males, suggesting that academic capital drives philosophy uses of the site more than does friendship and networking. Secondary analyses of law, history, and computer science confirmed the faculty advantage (in terms of higher profile views) except for females in law and females in computer science. There was also a female advantage for both faculty and students in law and computer science as well as for history students. Hence, Academia.edu overall seems to reflect a hybrid of scholarly norms (the faculty advantage) and a female advantage that is suggestive of general social networking norms. Finally, traditional bibliometric measures did not correlate with any Academia.edu metrics for philosophers , perhaps because more senior academics use the site less extensively or because of the range informal scholarly activities that cannot be measured by biblio-metric methods.

Linda Wilks

This report summarises research conducted in the Open University during January 2009 which looked at OU technology-enabled scholarly networking activity. The research found that social networking and scholarly networking are blurred in web 2.0 environments. Scholarly networks comprise a range of stakeholders, including academics, academic-related staff, the institution, students and the general public. The tools in use include commercially provided networks such as Facebook, Ning and Twitter, and OU-driven networks such as Platform and the Knowledge Network. The online research repository, ORO, is identified as a model of good information management practice. The need to incorporate informal information management tools, such as tagging is also stressed, however. The move towards the provision of open access to resources is found to underpin the OU’s extensive provision of high quality materials in multi-media formats to the general public. Issues of security, personal privacy, time management and training are also highlighted. Recommendations for the next steps are made, including the components of a dedicated arts and humanities scholarly network.

Library philosophy and practice

Noor Abutayeh , Khaldoon Al_Dwairi

This study sought to investigate information discovery and scholar networking as modes of scholarly communication across researchers in the Arab region. An online survey was distributed in December 2020 using the Google form. The questionnaire also includes the following elements: (a) what are the researchers' purposes of using electronic resources; (b) how do researchers look for and access scholarly material and (c) what methods of networking are mostly used for scholar connection. The findings revealed no significant differences across the groups, even when it comes to gender and respondents' discipline, it is clear that ResearchGate is the most popular among them all. Researchers holding degrees in Humanities and educational sciences like to use research platforms (M=4.37) more than social media (M=3.87). Moreover, the popularity of using Google Scholar and Google in scholarly field are confirmed in line with previous evidences. There are highly significant differences across researchers regarding their behaviours in accessing scholarly material. Results suggest that respondents don't consider researcher platforms like ResearchGate & Academia.edu as social media. It might be explained by the fact that research platforms like ResearchGate and Academia.edu are organized and designed for research purposes in a way that Facebook, Twitter and Instgram are not.

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• A Research Guide
• Writing Guide
• Article Writing

How To Write an Article Review

• Definition of article review
• Why do students write article reviews
• Types of article review
• Structure and outline
• Step-by-step guide

Article review format

• How to write a good article review
• Article review examples

Definition of article review assignments

Why do students write article reviews.

• Article writing is a deeply analytical process that helps students to correct vague terms when and if they are present. Likewise, when composing an article review or an original assignment, such work provides more clarity regarding using appropriate words. If an article has colloquial language or logical gaps, it is one of those aspects to mention in an article review. It also allows writers to determine whether certain terms must be replaced and edited.
• Article review essay writing helps to clarify scientific questions.
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• Most importantly, an article review is a way to encourage better work and provide critical analysis with due criticism and evaluation of the original article.

Types of article review tasks

• Original Research Article Review. The original research article review is close to what is often seen as the literature review. An author must explore the author’s hypothesis and some background studies with due analysis to outline scientific methods. It’s one of the most challenging tasks to write as one must interpret the findings and talk about future implications. This type of work can also get lengthy and be up to 6,000 words in subjects like History or Sociology.
• Critical Analysis. As the name implies, it critically evaluates the author’s work and can be up to 3,000 words.
• Literature Review. It stands for the review of secondary literature sources. As a rule, such reviews do not present much new data and only evaluate the importance of sources and information that supports the author’s arguments.
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• Meta-Analysis Reviews. Once again, it is a systematic review focusing on a specific topic, the literature issues. You must provide a special quantitative estimate for exposure and intervention.
• Clinical Trial Reviews. It means that one must provide a study related to an investigation offered by the author. It can relate to a drug or talk about a sample group of people, thus bringing it into the field of a defined population or a group of participants.
• Perspective or Opinion Article Review. This is where one poses an opinion, meaning things can get biased toward a certain opinion. In writing a good review, a student can look for perspectives and evaluate the importance of the original article. Likewise, posing an opinion is one of the obligatory aspects.

Article review structure and outline

Article review structure.

• Title page.
• An article introduction presenting the main subject and/or a problem.
• Brief article summary.
• Critical article evaluation and/or a summary.
• Conclusion with the moral lesson and discussion on the findings’ pros/cons.
• Bibliography with relevant citations.

Article review outline

• You provide an evaluation and summary of the author’s article.
• Your audience can receive sufficient knowledge regarding the subject.
• You have made points about the strongest arguments of the author.
• You have criticized the author’s work and explained how it contributes to the scientific field.
• You conclude your article review with your original thoughts and opinions without turning to additional research unless the grading rubric required it.

Step-by-step writing guide

Step 1: learn about the article’s agenda., step 2: summarize the main article ideas, step 3: organization aspect of the review, step 4: article preview and take notes, step 5: paraphrasing and analysis, step 6: final evaluation.

• An introduction. The topic of your study must be mentioned here in the first sentence. Indicate what your article contains and talk about the author’s background. Provide an order of the subjects you plan to discuss to explain what your readers expect. The introduction should provide the author’s claims and the main arguments that result in your thesis statement. When writing an introduction, you must determine the main argument.
• Body paragraphs. This is where you provide an evaluation with a summary and write about the author’s work.
• Conclusion. Speak of your reasons for providing a review and talk about whether you could support your thesis and what you have learned.
• Works Cited page. Refer to your grading rubric to identify what citation style must be used.

How to write a good article review?

• Do not write the statements in the first person. It is recommended to use the third person instead by turning to a formal academic tone.
• Your introduction with the information about the original article should take from 10 to 25% of your assignment’s volume.
• An introduction must end with a strong thesis and make an assumption or research the author’s main claim. A typical thesis to start an article review for an assignment may look this way:
• Write down all the important points and share your findings. It will help to show that you have done your homework correctly.
• Discuss how the article supports the claims and whether it provides good evidence.
• Always provide background information about the author.
• Use direct quotes to support your claims by turning to the original article.
• Read your summary twice to evaluate whether it follows the main thesis.
• Talk about the contributions of the author to the academic community.
• Provide reasons for whether you support the author’s view or not. Why or why not?
• Summarize all the important points in a conclusion part.

Why choose article review examples?

• Wright State University’s Journal Article Review Example .
• University of Illinois Springfield’s Article How-to Review Guide .
• UC Merced Library’s Article Review Sample
• Identify recent and important changes in your field of study.
• Determine who works in a specific field of science and why.
• Narrow things down and identify essential information to help you start with research.
• Use obtained information in school debates, and references work.
• Generate new ideas and conduct lab experiments.
• Write an article review through the lens of personal experience and expertise.

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Merkel cell carcinoma overlapping Bowen’s disease: two cases report and literature review

• Open access
• Published: 26 April 2024
• Volume 150 , article number  217 , ( 2024 )

Cite this article

You have full access to this open access article

• Xueqin Chen 1 ,
• Xiao Song 1 ,
• Hui Huang 1 ,
• Lian Zhang 1 ,
• Zhiqiang Song 1 ,
• Xichuan Yang 1 ,
• Shanchuan Lei 2 &
• Zhifang Zhai 1  

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin, which mainly occurs in the sun exposed sites of white patients over 65 years, with a higher recurrence and metastasis rate. Clinically, MCC overlapping Bowen’s disease (BD) is a very rare subtype of MCC. Few cases in the literature have been described and the management is not well defined. We summarize and update the epidemiology, clinical and histopathological features, metastasis characteristics, local recurrence rate and management of it by presenting two cases of MCC overlapping BD and reviewing the literature over the last 11 years.

We consulted databases from PubMed, ResearchGate and Google Scholar by MeSh “Merkel cell carcinoma” and “Bowen’s disease”, “Bowen disease” or “squamous cell carcinoma in situ”, from January 2013 to December 2023 and reviewed the literatures. We reported two additional cases.

Total 13 cases of MCC overlapping BD were retrospectively analyzed, in whom mainly in elderly women over 70 years, the skin lesions were primarily located on the faces, followed by the extremities and trunk. Most of them were asymptomatic, firm, dark red nodules arising on rapidly growing red or dark brown patches, or presenting as isolated nodules. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. All cases were confirmed by histopathology and immunohistochemistry. The most definitive treatment was extended local excision, but local recurrences were common. Of the 13 cases, 4 cases experienced local or distant metastasis. One suffered from an in-transit recurrence of MCC on the ipsilateral leg after local excision and lymph node dissection, whose metastasis completely subsided after avelumab treatment and without recurrence or metastasis during 6 months of follow-up.

Conclusions

MCC overlapping BD is a very rare skin tumor mainly predisposed on the faces, with high misdiagnosis rate and recurrence rate. Advanced disease at diagnosis is a poor prognostic factor, suggesting that earlier detection may improve outcome. The acronym, AEIOUN, has been proposed to aid in clinical identification. Our reports and the literature review can provide a better awareness and management of it.

Avoid common mistakes on your manuscript.

Introduction

Merkel cell carcinoma (MCC) is a rare and highly aggressive primary cutaneous neuroendocrine carcinoma, which predominantly affects individuals of Caucasian descent. Risk factors include advanced age, exposure to ultraviolet radiation, male gender, immunosuppression, hematologic malignancies or posttransplant status, and infection with Merkel cell polyomavirus (MCPyV) (Harms et al. 2018 ). It is characterized by high invasiveness, frequent local recurrence, a tendency for regional lymph node and distant metastases, with high mortality rates of 33–46% (Harms 2017 ; Garcia-Carbonero et al. 2019 ).

MCC often occurs in sunexposed sites, typically presenting as solitary nodules or patches with skin-colored, red or purple hues. Reportedly, it occured concomitantly with or in the setting of pre-existing cutaneous neoplasms, including actinic keratosis, Bowen’s disease (BD), squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and miscellaneous adnexal tumors (Kervarrec et al. 2022 ). Only a small percentage of MCC presented combined with other tumors, for which, current data have suggested a more aggressive course than pure MCC (Tono et al. 2015 ; Chattopadhyay et al. 2020 ). Clinically, its association with BD is exceedingly uncommon. Its unspecific manifestations often lead to delayed diagnosis clinically, which is necessary for dermatologists and oncologists to familiarize themselves with and recognize it (Swain et al. 2022 ).

Few cases in the literature have been described and the management is not well defined. In our paper, we reviewed the literature and reported two additional cases to summarize the epidemiology, clinical and histopathological characteristics and management of it.

We first reported two cases with MCC overlapping BD. Then, we searched different databases, including PubMed, ResearchGate and Google Scholar by the combination MeSh of “Merkel cell carcinoma” and “Bowen’s disease, “Bowen disease” or “squamous cell carcinoma in situ” from January 2013 to December 2023. Total 15 papers were identified. Inclusion criteria were systematic review or meta-analysis of randomized controlled trials, review, retrospective comparative reviews/studies and case series. Exclusion criteria were laboratory studies and non-English translated articles. A wide review of the bibliography of each of the selected articles was performed. In total, 10 papers met our inclusion criteria, including 11 case reports and case series.

We reviewed and analyzed all of the cases with MCC overlapping BD and summarized the demographic information, such as the age, sex and the medical history, clinical and histopathological characteristics and the treatment and prognosis of them.

Case reports

Case 1 A 51-year-old man presented with a pruritic erythema on the right waist for over 5 years. In the past years, he paid no attention to it, though a dull red nodule had developed and gradually enlarged on the erythema. Physical examination revealed a 5 cm × 3 cm oval-invasive erythema covering with some scale, in the center of which a dull red, solid, non-tendor, well-demarcated nodule measuring 3 cm × 2 cm × 2 cm protruded from the skin surface. Significant hyperplasia of dilated capillaries, and a few scales can be seen on the surface of the neoplasm (Fig. 1 a). Thoracoabdominal CT revealed no significant abnormalities, and peripheral blood count and tumor marker tests were normal.

Case 2 An 87-year-old female presented with an asymptomatic neoplasm on the right maindibular angle for over a year. Physical examination showed a dull red patch measuring 2 cm × 1.5 cm , with a solid, well-defined and protruding nodule in the center measuring  1.5 cm × 1.5 cm × 1 cm, and with some scaling (Fig. 1 b). There were no positive findings by the cranial and thoracoabdominal CT scans.

Biopsies were performed respectively on the neoplasms in both cases. Both the histopathological examination of the two cases revealed gross hyperkeratosis with parakeratosis overlying a thickened dysplastic epidermis, with the atypical mitoses and multinucleated tumor giant cells. A small blue cell tumor extended deeply into the subcutaneous fat under the low-power magnification, and the pathognomonic tumor nuclei were large and pale staining and contain tiny nucleoli (Fig. 2 a–f). Immunohistochemistry of case one showed positivity for CK, CK20, EMA, Synaptophysin (Syn) and Bcl-2 (Fig. 3 a–d). Vimentin was positive in the stroma, while CD3, CD4, CD8 and CD20 showed scattered positivity. Ki67 was positive in 90% of tumor cells. LCA, CD68, CD30, TdT, CD56, Mum-1, TIA1, Granzyme B, EBER, Neuron-Specific Enolase (NSE), Chromogranin A (CgA) and CD79a were negative. In case two, immunohistochemistry showed positivity for CD56, focal positivity for CK, CK20, CAM5.2 and CgA, and negativity for Syn and CK7. Ki67 was positive in 80% of cells (Fig. 4 a–f)

Clinical aspect of an MCC overlapping BD. a Solitary and dome shaped reddish nodule surrounded by an erythematous scaly patch on the right waist. b Ovoid dark erythematous painless tumor mass on the right mandibular angle, with peeling and scabbing on the surface of the mass

a, b On histopathology, BD is juxtaposed or strictly intermingled with MCC (H&E, ×4). c, d BD shows full thickness of atypical squamous cells (H&E, ×10). e, f Dermal dense infiltration of small round hyperchromatic small cells (H&E, ×10)

a–c Immunohistochemical staining showed that CK, CK20 and Syn were positive Magnification: ×10. d Immunohistochemical staining showed that Ki67 was positive in 90% of the cells Magnification: ×10

a Immunohistochemical staining showed CD56 positive Magnification: ×10. b–e Immunohistochemical staining showed that CK, CK20, CAM5.2 and CgA were focally positive Magnification: ×10. f Immunohistochemical staining showed that Ki67 was positive in 80% of the cells Magnification: ×10

Both patients were diagnosed with MCC overlapping BD. They all underwent surgical excision extending 1 cm beyond the tumor margins. There was no recurrence during a follow-up period of 3 years in case one and about half a year in case two.

Literature review

The demographic data.

In the last 11 years (from 2013 to 2023), only 13 cases (including our two cases) of MCC overlapping BD have been described in the literature. The incidence was slightly higher in females than in males, with a male-to-female ratio of 1:1.6 (5 cases to 8 cases). The age ranged from 32 to 87 years (mean 72 years, median 73 years). Lesions mainly occurred at the age of more than 70 years (77%), and only one extremely rare case occurred at the age of 32 years. The overall duration of the disease varied from 2 months to 5 years. Some patients had a history of annual herbal pill consumption, exposure to ultraviolet radiation, and previous diagnoses of multiple myeloma, basal cell carcinoma, and BD (Choe et al. 2014 ; Miraflor et al. 2016 ) (Table 1 ).

Clinical manifestations

All the studies reported the location of the lesions. MCC overlapping BD were mostly located on the faces ( N = 7/13, 53.8%), followed by the trunk ( N = 3/13,23.1%), the upper extremity ( N = 1/ 13,7.7%) , lower extremity ( N = 1/ 13,7.7%) and groin ( N = 1/ 13,7.7%). No patient had multiple lesions (Table 1 ).

Information regarding the initial clinical presentation was available for all patients. The lesions were most frequently described as asymptomatic, firm, dull red nodules on red or dark brown patches with frequent rapidly growing behavior, or as solitary nodules. None of the lesions described with accuracy were correctly diagnosed before biopsy and histological examination. The size of the tumor lesions was available for 11 lesions (84.6%). Tumor diameters ranged from 0.3 to 6.5 cm (mean: 2 cm, median: 1 cm). Rapid growth, either of new lesion or stable lesion from several months was the most frequent motivation for biopsy and diagnosis (Table 1 ).

Locoregional or distant metastases occurred in four patients (30.8%) (Swain et al. 2022 ; Choe et al. 2014 ; Ishida et al. 2013 ; Kiyohara et al. 2019 ). One patient showed lymph node and liver metastasis (Choe et al. 2014 ). After local excision of the cutaneous lesion and left inguinal lymph node dissection in one patient, several dermal and subcutaneous nodules developed successively on the left lower extremity (Kiyohara et al. 2019 ) (Table 1 ).

All 13cases had a histological diagnosis of MCC overlapping BD (Table 1 ). Eight patients were diagnosed by histopathology, followed by extensive local excision treatment. Of them, an 82-year-old female was diagnosed with MCC overlapping BD by histopathology but refused further evaluation and operative treatment (Jeong et al. 2018 ). Seven patients underwent direct extensive local excision treatment, followed by histopathological detection of the tissue post-surgery (Tono et al. 2015 ; Swain et al. 2022 ; Choe et al. 2014 ; Miraflor et al. 2016 ; Ishida et al. 2013 ; Kiyohara et al. 2019 ; Yamamoto 2014 ; McGowan et al. 2016 ; Casari et al. 2018 ). A 77-year-old woman was found to have lymph node and liver metastases after surgical treatment, followed by radiation and chemotherapy (Choe et al. 2014 ). A 65-year-old Japanese man experienced recurrent skin lesions after local surgery and lymph node clearance. After receiving avelumab treatment for 2 months, all lesions disappeared completely. Subsequent follow-ups over six months showed no recurrence (Kiyohara et al. 2019 ). A 32-year-old lady underwent surgery, lymph node clearance and received radiation therapy. This patient had an axillary dissection because of a palpable lymph node. Two lymph nodes out of 14 showed metastatic deposits, hence the female patient received radiotherapy after which she is well and completely free of disease now, 7 years after the initial diagnosis (Swain et al. 2022 ). A 71-year-old Caucasian male remained recurrence-free during the 1-year follow-up after surgical treatment (Miraflor et al. 2016 ). The follow-up status for the remaining seven patients has not been reported.

• Histopathology

Histopathologically MCC primarily locates within the dermis and can invade subcutaneous tissues. At low magnification, it appeared as a typical small round blue-cell tumor, comprising three different histologic subtypes: trabecular type, intermediate type and small cell type. Among them, the intermediate type was the most common. The tumor consisted of nodules and diffuse sheets of basophilic tumor cells with vacuolated, pale-staining nuclei containing small nucleoli. The cytoplasm was indistinct with common nuclear folding. The trabecular type, the least common, was composed of slender, uniformly shaped cells, often with nuclear folding. The small cells type was characterized by infiltrates of deeply staining 'oat cell-like' cells with significant cell fragmentation.

The histopathological feature of MCC overlapping BD include abnormal keratin-forming cells of BD within the epidermis and small round blue-staining cells of MCC in the dermis. There has been a case reported where the MCC component, in association with BD, was confined to the epidermis, referred to as “intraepidermal MCC”(Miraflor et al. 2016 ).

The immunohistochemical characteristics of MCC overlapping BD indicate that MCC cells express neuroendocrine markers such as NSE, CK20, Neurofilament (NF), CgA, and Syn. Most MCCs do not express Thyroid Transcription Factor-1 (TTF-1). On the other hand, BD commonly exhibits expression of squamous cell markers like CK5/6, CK10 and CK14.

Dermoscopic examination was only reported in two patients (Casari et al. 2018 ). Dermoscopic examination showed the presence of clustered dotted vessels over a reddish structureless area that was suggestive for the diagnosis of BD. Addittional dermoscopical characteristic of the nodule included an atypical vascular pattern with tortuous vessels overlying a whitish background.

MCC is a primary cutaneous neuroendocrine carcinoma, predominantly diagnosed in fair-skinned elderly populations. Characterized by its aggressive nature, MCC is particularly notorious for its tendency towards local recurrences and distant metastases (Siqueira et al. 2023 ). Interestingly, MCC lesions may coexist with, or be found in close proximity to, a variety of other neoplasms, including actinic keratosis, BD, invasive SCC, BCC and sweat gland tumors (Kervarrec et al. 2022 ; Hobbs et al. 2020 ). Clinically, cases of MCC coexisting with BD are very rare. This comprehensive review of the literature spanning the past decade has revealed a notably rare occurrence, identifying only 11 cases of MCC overlapping BD. At the same time, we reported another two cases with MCC overlapping BD in the paper.

The annual incidence rate of MCC is approximately 0.24 cases per 100,000 individuals, showing a trend of exponential increase. This rising incidence can be attributed to a confluence of factors, including demographic shifts towards an aging population, heightened use of immunosuppressive agents, significant improvements in diagnostic technologies facilitating earlier and more accurate detection, and a general enhancement in clinical vigilance and awareness regarding this malignancy (Mistry et al. 2023 ; Mohsen et al. 2023 ). Our retrospective examination has disclosed that incidences of MCC overlapping BD present a gender distribution, with a male-to-female ratio of 1:1.6. Notably, a higher prevalence is observed in females, a finding potentially attributable to the limited scope of the sample size. The pathological manifestations of MCC predominantly arise in individuals aged over 70, though a sporadic occurrence in middle-aged adults has been noted (Swain et al. 2022 ). Owing to the absence of a conclusive diagnosis in MCC patients before undergoing histopathological examination, recent research has offered valuable insights into the clinical presentation of MCC, coalescing into the AEIOU mnemonic for ease of recall. “A” stands for asymptomatic lesions, often presenting without pain or tenderness. “E” denotes rapid expansion, with lesions demonstrating notable enlargement over a period of just three months. “I” represents immunosuppression, a key risk factor, encompassing conditions such as HIV infection, post-solid organ transplantation, or chronic lymphocytic leukemia. “O” refers to individuals over the age of 50, a demographic showing increased susceptibility. Finally, “U” highlights ultraviolet exposure in fair-skinned individuals as a significant risk factor. In the context of MCC overlapping BD, we propose the “AEIOUN” guideline, wherein “N” signifies the rapid emergence of nodules on the foundation of erythematous patches, expanding upon the initial AEIOU criteria.The presence of three or more of these features warrants a heightened clinical suspicion of MCC or MCC overlapping BD, guiding the clinician towards appropriate diagnostic and therapeutic interventions (Siqueira et al. 2023 ; Brusasco et al. 2022 ; Mistry et al. 2023 ).

The etiology of MCC is multifactorial. Current research posits that infection with MCPyV and genetic mutations triggered by ultraviolet (UV) radiation are primary contributors to the pathogenesis of MCC (Yang et al. 2022 ). Specifically, UV radiation plays a critical role in the development of MCPyV-negative MCC cases. Intriguingly, MCC cases that present concurrently with SCC or BD predominantly lack MCPyV. Among the 13 cases of MCC overlapping BD that were reviewed, only three patients underwent testing for MCPyV, and all 3 cases were negative for MCPyV. This observation suggests a distinct oncogenic mechanism in composite MCC, diverging from the pathways observed in solitary MCC (Kervarrec et al. 2022 ). The simultaneous manifestation of MCC overlapping BD might be attributed to a confluence of various factors, including immune regulation and the intricacies of the tumor microenvironment (Chattopadhyay et al. 2020 ). Genetic predisposition also appears to play a significant role in this context. Moreover, the pathogenesis of these conditions may be exacerbated by immunosuppression, immune deficiency or immune system dysregulation. The interplay and communication among cells within the tumor microenvironment, particularly through the release of cytokines, are believed to significantly influence the coexistence of MCC overlapping BD. Furthermore, lifestyle choices and environmental exposures, such as to chemicals, ultraviolet radiation, or toxins, are potential contributory elements in the concurrent development of these dermatological conditions (Casari et al. 2018 ).

MCC is unequivocally diagnosed through histopathological examination, recognized as the definitive gold standard. This is often supplemented by immunohistochemical profiling to accurately distinguish MCC from other poorly differentiated neoplasms. A significant majority of MCC cases demonstrate cytokeratin expression, with approximately 95% exhibiting perinuclear and/or cytoplasmic positivity for CK20 or CAM5.2. Additionally, these carcinomas frequently express neuroendocrine markers, most notably Syn, CgA, CD56 and NF. In contrast, TTF-1 and CDX-2 are typically negative in MCC (Khanna et al. 2020 ). Emerging studies suggest that around 60% of MCC cases express the protein p63, which is potentially correlating with a decreased overall survival rate and a lower disease-specific survival rate of patients. CK7 expression is generally absent in MCC, while there are noteworthy instances of CK7 positivity. A notable aspect in the immunohistochemical landscape of MCC is positive for MCV, observed in about 55% to 90% of cases. Interestingly, MCV-negative cases frequently demonstrated a lack of NF expression, and they distinctively exhibit markers of follicular stem cells along with a higher incidence of p53 positivity, which are predominant in CK20-negative MCCs. In patients with MCC overlapping BD, a distinctive dual pathology is often revealed through marker expression. The immunohistochemical signature of MCC is characterized by the concurrent expression of epithelial markers, including AE/1AE3, CAM5.2 and a broad spectrum of cytokeratins, alongside neuroendocrine markers such as neurofilaments and neuron-specific enolase. In contrast, BD typically demonstrates positive immunoreactivity for markers like CK7 and p16. Notably, an uncommon immunophenotype has been documented in a case merging MCC overlapping BD. In some cases, the MCC cells exhibited an absence of CK20 expression while maintaining positivity for CK7.

This diagnostic approach assumes critical importance in instances where MCC coexists with other tumors derived from epidermal origins. In conducting histological evaluations, it is imperative to scrutinize for the co-occurrence of other tumor types, such as SCC (observed in up to 15% of cases) or BCC. A critical aspect of the assessment is determining the extent of epithelial involvement by the tumor, whether the tumor cells are situated within the epidermis or affect the cutaneous adnexa. Furthermore, a detailed examination of the tumor's morphological attributes is essential, including discerning whether the tumor presents as infiltrative or manifests as well-defined nodular formations, alongside evaluating the dimensions (ranging from small to large) and the particular morphology of the cells, which can determine the appropriate treatment strategies and the prognosis of the tumors. The extent of invasion, growth patterns, and overall prognosis of MCC tumors exhibit significant interrelations (Gonzalez et al. 2022 ). Notably, patients exhibiting sentinel lymph node involvement typically will face a more challenging prognosis. Similarly, individuals suffering from active hematologic malignancies or under immunosuppression are also likely to experience adverse outcomes. Research on the differential prognosis or metastasis rates between MCC and MCC overlapping BD remains scarce. However, the co-occurrence of MCC overlapping BD may signal a broader spectrum of skin damage and an elevated risk of recurrence or metastasis.

The treatment of MCC overlapping BD adheres to the principles established for MCC treatment (Green et al. 2022 ; Harvey et al. 2022 ). In the management of MCC, surgical excision is often considered the primary modality of treatment. This involves employing techniques such as Mohs micrographic surgery or its modified forms, ensuring a margin of 1–2 cm extending to the fascia or periosteum (Uitentuis et al. 2022 ). For metastatic, post-surgical residual, or recurrent MCC, a combination of radiotherapy and chemotherapy serves as effective adjunctive treatment modalities. In recent advancements, immunotherapies targeting various anti-tumor immune mechanisms, particularly therapies focused on the PD-1 and PD-L1 pathways, have emerged as frontline treatments for metastatic MCC (Harms et al. 2018 ; Becker et al. 2018 ). Agents such as Avelumab, Pembrolizumab, and Nivolumab have been instrumental in significantly prolonging patient survival in these cases (Fojnica et al. 2023 ; Topalian et al. 2020 ).

The coexistence of MCC overlapping BD represents an exceedingly rare condition, necessitating further research and accumulation of cases to better comprehend its clinical characteristics and determine the optimal therapeutic regimen. It is a lesion with nonspecific features and dermoscopy evaluation can be helpful for improving the clinical suspicion. We introduce the concept of “AEIOUN” as a pioneering approach for the early identification of clinically suspicious lesions indicative of MCC overlapping BD. The excision of doubtful nodular lesions is mandatory especially in the elderly, because MCC overlapping BD has not only a tendency to recur locally, but it can also metastasize. However, due to its rarity, there are no well-defined guidelines for the management. Complete surgical excision with clear margins stands as the optimal therapeutic choice, complemented by adjuvant radiotherapy, chemotherapy, immunotherapy, or their combination. Regular follow-ups are strongly recommended to monitor the condition. These two case reports and the review of the literature can provide better awareness and management of this rare tumor.

Data availability

All data generated or analyzed during this study are included in this published article.

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Department of Dermatology, Southwest Hospital, Army Medical University, No. 30, Gaotanyan Street, Shapingba District, Chongqing, 400038, China

Xueqin Chen, Xiao Song, Hui Huang, Lian Zhang, Zhiqiang Song, Xichuan Yang & Zhifang Zhai

Department of Dermatology, Yongchuan Hospital of Chongqing Medical University, No. 439, Xuanhua Road, Yongchuan District, Chongqing, 402160, China

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XC, SL and ZZ: designed the research; XS, HH and LZ: performed the research; ZS and XY: contributed vital analytical tools; all authors contributed to manuscript revisions and approved the final version of the manuscript.

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Chen, X., Song, X., Huang, H. et al. Merkel cell carcinoma overlapping Bowen’s disease: two cases report and literature review. J Cancer Res Clin Oncol 150 , 217 (2024). https://doi.org/10.1007/s00432-024-05743-0

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Received : 07 March 2024

Accepted : 04 April 2024

Published : 26 April 2024

DOI : https://doi.org/10.1007/s00432-024-05743-0

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