Marketo is set up to accept duplicate records from your CRM. Must make sure no reps can create new records without some process in place first to reduce potential dupes
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As Adam and Kristen have pointed out, Marketo will update/append existing records by their recent modification time stamp. Also, If you have a proces where by you need to push Contacts to a queue in SFDC, then Marketo can create a duplicate lead record in SFDC because Contacts can't be in Lead queues (SFDC functionallity).
Some things to be aware of.