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