Dr. Kevin Ko on Biomarkers, Oral Dysplasia, and the Limits of H&E Diagnosis

Christine interviews Dr. Kevin Ko (DMD, MD), a pathologist at the BC Cancer Agency with training in oral and maxillofacial pathology, anatomic pathology, and dermatopathology. They discuss his ASDP 2025 lecture on using p53 in oral dysplasia as a potential new approach and the broader problem of diagnostic discordance and over-diagnosis when relying on H&E alone. Dr. Ko shares examples from practice, including recognizing oral porokeratosis (previously followed as dysplasia for years) and a chemotherapy-related lip lesion initially suspected to be severe dysplasia but supported by wild-type biomarker results and clinical history, resolving after stopping chemotherapy drugs. He emphasizes the need for reproducible biomarkers and possibly molecular-based classification to improve consistency and patient outcomes, while also describing the pressure to be near-perfect in pathology, the risk of burnout, and efforts to build sustainable systems (QA sessions, colleague consultation, protected time). The conversation closes with his approach to presentations as storytelling, interest in prospective multi-center research, and a final message about balancing perfectionism with rest while remaining open-minded to new diagnostic methods to improve patient care.

00:00 Welcome & Meet Dr. Kevin Ko (DMD/MD, Dermpath at BC Cancer)

01:00 The Controversial Idea: Using p53 Biomarkers in Oral Dysplasia

01:18 Oral vs Skin Pathology: Discovering Porokeratosis in the Mouth

02:07 Diagnostic Error & Overdiagnosis: Why Reproducible Biomarkers Matter

05:19 Case Study: “Severe Dysplasia” vs Toxic Erythema of Chemotherapy —Context Changes Everything

06:36 The Perfectionism Trap in Pathology (and Why 95% Isn’t Good Enough)

08:04 Burnout, QA Systems, and Building Sustainable Workflows

09:14 Work–Life Balance, Kids, and Choosing Priorities (Family vs Research)

11:14 How to Build a Great Talk: Storytelling, Cases, and Future Studies

11:38 Final Takeaways: Balance, Open-Mindedness, and Better Diagnostics

Dr. Raymond Barnhill on Diagnostic Drift, Uncertainty, and the MPATH-Dx V2.0 Approach to Melanocytic Lesions

In this episode of The Girl Doc Survival Guide, Christine interviews Dr. Raymond Barnhill, a world-recognized dermatopathology expert known for work on diagnostically challenging melanocytic lesions, melanoma pathology references, and contributions to WHO skin tumor classification and AJCC melanoma staging. Dr. Barnhill shares career anecdotes and key communities at Yale and in Boston, collaborations with numerous melanoma leaders, and the founding of the North American Melanoma Pathology Study Group and the International Melanoma Pathology Study Group, as well as participation in the NIH-funded MPATH Study Group. The discussion focuses on overdiagnosis, underdiagnosis, and diagnostic discordance in melanocytic lesions, including evidence of diagnostic drift toward calling more lesions melanoma over time and the overlap between melanoma criteria and atypical/dysplastic nevi. He describes MPATH research, explains the revised MPATH-Dx V2.0 schema, explicitly recognizing uncertainty along a continuum rather than a strict benign/malignant threshold. He emphasizes practical diagnostic approaches including measuring lesion size (noting a 4 mm threshold associated with conventional dysplastic nevi and increasing concern at larger sizes), focusing on key architectural features (junctional nest variation/disarray and lentiginous proliferation), using nuclear size relative to keratinocyte nuclei (including a 1.5× threshold and counting atypical cells per high-power field) while accounting for site-specific pitfalls such as scalp nevi. The conversation also covers “gestalt” versus systematic review, the importance of due diligence using full clinical and morphologic information before ancillary testing, and cautions against overreliance on immunohistochemistry or molecular tests. Dr. Barnhill closes with career advice ends with a message that setbacks can be opportunities for growth.

00:00 Welcome + Meet Dr. Raymond Barnhill (Dermatopathology Legend)

01:51 Career Origins & Melanoma Pathology Mentors (Yale → Boston)

03:59 Building Melanoma Pathology Study Groups (North American & International)

05:57 Overdiagnosis, Diagnostic Drift & Why Discordance Happens

09:43 Inside the MPATH Study: Measuring Interobserver & Intraobserver Agreement

11:39 MPATH-Dx V2.0 Explained: Standardized Classes & Treatment Guidance

13:59 Redefining “Low-Risk” Melanoma: Stringent pT1a Criteria + Embracing Uncertainty

18:47 Practical Grading Tips: Lesion Size, Architecture & Nuclear Atypia Thresholds

22:42 Gestalt vs Due Diligence: Avoiding Traps + Using IHC/Molecular Wisely (PRAME)

28:39 Career Advice: Passion, Mentors, Community + Final Reflections

Balancing Careers and Family: Insights from Dr. Thomas Helm

In this episode of The Girl Doc Survival Guide, Christine invites Dr. Thomas Helm, MD, for his second appearance on the podcast. Dr. Helm, former Head of Dermatology and Director of Dermatopathology at Buffalo Medical Group, now working at Penn State Hershey Medical Center, shares his extensive experience and personal anecdotes. They discuss generational changes in the medical field, challenges faced by women in medicine, and the importance of work-life balance. Dr. Helm emphasizes the significance of understanding work culture, making intentional career decisions, and maintaining work-family harmony. He reflects on his career transition to academia and the rewarding relationships he has built along the way. The conversation delves into the importance of community, mentoring, and the profound impact of prioritizing meaningful relationships over individual autonomy.

00:00 Introduction and Guest Welcome

00:45 Personal Anecdotes and Family Influence

01:22 Changes in Medical Field Demographics

02:10 Challenges for Women in Medicine

02:39 Balancing Career and Family

04:50 Mentorship and Career Advice

06:46 Prioritizing Relationships and Community

10:53 Transition to Academia and Personal Growth

18:52 Final Thoughts and Gratitude

Overcoming Decision Paralysis: Insights from Dr. Mary Steffel

In this episode of The Girl Doc Survival Guide, we welcome Dr. Mary Steffel, an Associate Professor of Marketing at Northeastern University. Dr. Steffel delves into the phenomenon of decision paralysis, drawing from her extensive research on consumer judgment and decision making. She shares personal anecdotes, including her illustrative experience playing Cinderella, and discusses practical strategies for managing complex decisions. Key solutions include delegating decision-making to others and simplifying choices. Dr. Steffel also offers advice for healthcare providers to help patients navigate medical decisions. The conversation covers the importance of recognizing decision fatigue and planning decision-making for optimal times.

00:00 Introduction and Guest Welcome

00:56 Personal Anecdote: Cinderella and Decision Paralysis

02:15 Understanding Decision Paralysis

03:54 Real-World Example: Medicare Drug Plans

05:25 Delegating Decisions: A Practical Approach

09:58 Medical Decision Making: Simplifying Choices

14:07 Overcoming Decision Fatigue

15:49 Conclusion and Farewell

In Conversation with Dr. Wolfgang Weyers: The Complexities of Dermatopathology Diagnosis

In this episode of The Girl Doc Survival Guide, Christine welcomes Dr. Wolfgang Weyers, a highly respected dermatopathologist and author, to discuss his experience and perspectives on medical diagnosis. Dr. Weyers shares a personal anecdote about his influential mentor, Dr. Bernie Ackerman, and dives into a critical discussion on overdiagnosis, the importance of specific diagnosis in dermatopathology, problems caused by partial samples, and the criteria for diagnosing melanoma. He emphasizes the importance of experience, proper training, and the need to biopsy adequately developed lesions. The conversation also touches on the complexity of biological classification and the role of behavior and molecular studies in understanding diseases.

00:00 Introduction to Dr. Wolfgang Weyers

00:46 Personal Anecdotes and Influences

02:05 Discussion on Overdiagnosis

05:04 Criteria for Melanoma Diagnosis

08:34 Challenges in Diagnosis and Solutions

16:48 Final Thoughts and Conclusion

Overdiagnosis and Medical Decision Making with Dr. Kathleen Kerr

In this episode of The Girl Doc Survival Guide, Dr. Kathleen Kerr, a Professor of Biostatistics at the University of Washington, discusses overdiagnosis and medical decision making. Dr. Kerr delves into how patients perceive mammogram results, the difference between overdiagnosis and overcalling, and the challenges pathologists face in diagnosing cancer. She also shares findings from her research on the influence of prior opinions on second diagnoses and the cognitive processes involved in interpreting pathology images. The discussion highlights the complexities and subjectivity in pathology diagnoses and the implications for patient care.

00:00 Introduction and Guest Welcome

00:33 Personal Anecdote on Mammograms

01:25 Understanding Screening and Its Limitations

02:24 Exploring Overdiagnosis

05:59 Research on Dermatopathologists' Perceptions

08:20 Second Opinions in Medical Decision Making

12:26 Pathologists' Diagnostic Process

15:42 Final Thoughts on Diagnostic Criteria

The Impact of Gaze and Fatigue on Medical Decision-Making with Dr. Bulat Ibragimov

In this episode of The Girl Doc Survival Guide, Christine interviews Dr. Bulat Ibragimov, an Associate Professor of Machine Learning and Medical Imaging at the University of Copenhagen. Dr. Ibragimov shares personal anecdotes and discusses his research on the role of artificial intelligence and eye tracking in medical decision-making. Key topics include the impact of gaze patterns and fatigue on diagnostic accuracy, the potential for AI to recognize when doctors may make errors, and how individualized gaze patterns can indicate the level of expertise and certainty in medical professionals. The conversation explores the implications of this research for improving the integration of AI in medical practices and enhancing training and decision-making processes for healthcare professionals.

00:00 Introduction and Guest Introduction

00:49 Personal Anecdote and Background

01:46 Eye Tracking and Medical Decision Making

03:18 Patterns in Gaze and Error Prediction

11:00 Fatigue and Its Impact on Accuracy

16:09 AI and Gaze Analysis in Medical Training

20:07 Conclusion and Final Thoughts

Exploring Wellbeing, Motivation, and Lifelong Learning with Dr. Oksana Babenko

In this episode of The Girl Doc Survival Guide, Christine welcomes Dr. Oksana Babenko, an Associate Professor at the University of Alberta, to discuss themes of wellbeing, motivation, and lifelong learning. Dr. Babenko shares her personal journey from the Soviet Union to Canada, her academic inspirations, and how her experiences in sports have shaped her approach to challenges and burnout. The conversation delves into her research on the importance of exercise in managing burnout among medical students and professionals. Dr. Babenko emphasizes individualized approaches to maintaining psychological needs, the significance of a mastery mindset, and the value of staying curious in a complex world.

00:00 Introduction and Guest Welcome

00:35 Personal Anecdotes and Academic Journey

02:36 Path to Canada and Research Interests

04:19 Wellbeing, Motivation, and Lifelong Learning

05:09 Exercise as a Preventive Measure for Burnout

10:27 The Importance of Consistency and Intentionality

12:19 Autonomy, Competence, and Relatedness

14:36 Mastery Mindset and Need Crafting

15:42 Final Thoughts and Staying Curious