A number of Middle Stone Age (MSA) assemblages in northern Africa, as well as a few in South Africa and the eastern Mediterranean, preserve small mollusk shells, most notably estuarine and marine members of the sub- family Nassariinae (e.g., Nassarius kraussianus, N. circumcinctus, and Tritia gibbosula). In most of these instances, these small shells have additional holes, which were made by natural processes or humans. These holes have led some researchers to interpret these shells as having been used as beads or ornaments. Studies of traces from wear and ocher residues on these shells have supported this interpretation, but most lack traces of manufacturing. The antiquity of such shells in the archaeological record extends back to the early Late Pleistocene, and as such, these shells may provide the earliest consistent and geographically widespread evidence for human personal ornamen- tation in the world. Here we review what is known about each of these assemblages and their contexts?their spe- cies designations, relative abundances, context, antiquity, taphonomy, association with other aquatic resources, and analytical history. In doing so, we highlight similarities and differences between these assemblages. In par- ticular, we highlight the abundance and antiquity of these shells in northwestern Africa, and we compare them to similar shells from South Africa and Israel. We find that there are discrepancies in how these shells are described from different sites, and that this limits comparisons. We present some suggested criteria to be included in analy- ses of these shells, with the goal of improving comparative studies between assemblages. Personal ornaments are frequently identified in assemblages attributed to modern human arrival in western Asia and Europe. As such, the study of the antiquity and distribution of early personal ornament use in the African MSA has implications for our understanding of the expansion of modern humans out of Africa.