Marker sutures are often used for excised cutaneous lesions to aid histological analysis, however, there are no current guidelines to facilitate this in practice. The authors hypothesised that a lack of guidelines causes a variation in clinical practice and confusion of meaning between plastic surgeons and pathologists. This questionnaire-based study confirms the authors’ hypothesis and highlights a discrepancy both between surgeons and in individual surgical practice. More importantly, we identify discord between histopathologists and plastic surgeons in relation to marker suture placement and report interpretation, leading to potential undertreatment of patients. This paper adds to the growing literature calling for guidelines regarding marker suture placement for cutaneous excision biopsies.