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Each mark represents a specific "big boss", including end bosses, as well as the Boss Rush.
More importantly, each character unlocks something for getting each mark (with a few notable exceptions, but hush hush spoilers
To rephrase: getting the Cross mark as Isaac will unlock one thing, but getting that same mark as Cain will unlock something else. And getting all marks as Isaac will unlock one more extra thing.
You can see them as a to-do list for each character. Your "end goal" would be to get all marks, playing on hard, as everyone.
Below is the list of marks. I'll try to keep them light-ish on spoilers, reveal what you want. (Which is basically why I don't just link to the wiki page describing them.)
The marks are: (what they are - how to get them - how to reach that)
- Heart - beat the Womb 2 - win your first run to unlock the Womb.
- Cross - beat the Cathedral - beat the Womb 2 a total of 11 times to unlock a permanent access to the Cathedral. Can be reached early by getting an Angel room when killing the Heart.
- White photo - beat the Chest - beat the Cathedral 5 times to unlock the Polaroid on further runs (dropped by Mom). Take it, then beat the Cathedral again. The run won't end, you'll go to the Chest instead.
- Inverted cross - beat Sheol - beat the Womb 2 a total of 11 times to unlock a permanent access to Sheol. Can be reached early by getting a Devil deal when killing the Heart.
- Black photo - beat the Dark Room - beat Sheol 5 times to unlock the Negative on further runs (dropped by Mom). Take it, then beat Sheol again. The run won't end, you'll go to the Dark Room instead.
- Brimstone symbol - defeat the thing behind the big golden door - After beating the Chest or the Dark Room once, a giant golden door will be located in the starting room of both these floors. To open it, you must find both key pieces during the run. Angels must die.
- Star - beat the Boss Rush - accessible by killing Mom in less than 20 minutes.
- Face - beat Hush - accessible by killing Mom's Heart under 30 minutes
- Cent symbol - beat Greed mode - press up/down to change the game to Greed mode before starting a run. Note: hard Greed mode (known as Greedier) is unlocked by playing Greed mode.
- Damaged sheet borders - beat the Void - unlocked by killing Hush. Can be accessed on further runs by killing Hush again, or sometimes when killing other big bosses
- Knife - beat the Corpse - kill Hush 3 times to unlock the alternative path. On Downpour 2 and Mines 2, find both knife pieces. After killing the boss on Mausoleum 2, use the knife on the flesh door. Kill the boss behind it to reach the Corpse.
- Paper note - behind the door at the spawn of Depths 2 - kill Mom, take the Polaroid or Negative, teleport out of the boss room (a marked skull on the floor is guaranteed to drop a Fool tarot card), then touch the door in the spawn room of Depths 2. Reach the end of that path.
Don't pay too much attention to the last two on this list, they should make more sense once you're at that point. They're very late game, and that's the core of the content added by Repentance.