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Effects of contamination on aquatic organisms have been investigated and employed as biomarkers in environmental quality assessment for years. A commonly referenced aquatic organism, mollusks represent a group of major interest in toxicological studies. Both gastropods and bivalves have external mineral shells that protects their soft tissue from predation and desiccation. These structures are composed of an organic matrix and an inorganic matrix, both of which are affected by environmental changes, including exposure to hazardous chemicals. This literature review evaluates studies that propose mollusk shell alterations as biomarkers of aquatic system quality. The studies included herein show that changes to natural variables such as salinity, temperature, food availability, hydrodynamics, desiccation, predatory pressure, and substrate type may influence the form, structure, and composition of mollusk shells. However, in the spatial and temporal studies performed in coastal waters around the world, shells of organisms sampled from multi-impacted areas were found to differ in the form and composition of both organic and inorganic matrices relative to shells from less contaminated areas. Though these findings are useful, the toxicological studies were often performed in the field and were not able to attribute shell alterations to a specific molecule. It is known that the organic matrix of shells regulates the biomineralization process; proteomic analyses of shells may therefore elucidate how different contaminants affect shell biomineralization. Further research using approaches that allow a clearer distinction between shell alterations caused by natural variations and those caused by anthropogenic influence, as well as studies to identify which molecule is responsible for such alterations or to determine the ecological implications of shell alterations, are needed before any responses can be applied universally., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)