In this episode of Life by A Thousand Cuts podcast, A/Prof Tony Dicker sits down with Dr Ian Katz, a dual-trained pathologist and founder of several skin cancer clinics, to explore one of the most debated topics in skin cancer management: margins.
Dr Katz shares his unique perspective as both a pathologist and a clinician, reflecting on why confusion around margins persists, and how GPs can better interpret pathology reports in practice.
They discuss:
Clinical vs histological margins: Guidelines are based on clinical margins, not what’s measured under the microscope. A “1.5mm histological clearance” isn’t the same thing as a “5mm clinical margin.”
Measurement variability: Pathology reports aren’t exact science. A “2mm margin” often means “2mm ± 1–2mm.” Numbers give guidance, but they’re not absolute.
What really matters: In many cases, being histologically one cell clear is enough. The reason we aim wider is due to uncertainty, because we only ever see a small fraction of the specimen under the microscope.
Managing uncertainty: Skin cancer surgery comes with ambiguity. If you are someone who struggles to sleep without a precise answer, skin cancer work can feel uncomfortable. Understanding the limits of pathology helps.
Communication counts: Clear request forms (with the prior diagnosis, margin status, and level of clinical suspicion) make it easier for pathologists to provide meaningful reports.
This discussion is about bridging the gap between the clinical and pathology worlds, and recognising that margins are less about chasing numbers, and more about good clinical judgement, clear reporting, and thoughtful follow-up.
Watch this episode here.
This podcast series is designed to help you enhance your clinical decision-making, procedural skills, and confidence in skin cancer management. Focus on real-world cases, surgical techniques and tips, journal article reviews, diagnostic and management insights, and guest interviews with GPs and specialists.
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