It's not uncommon a tumor appearing in the form of a histological subtype or a microscopic variant, in such a way that makes more difficult the correct diagnosis. There's no remaining alternative for practitioner pathologists but to be aware, as much as possible, about subtypes and variants of tumors, thereby reducing the chances of rare features be misconstrued as evidence of another tumor, or even of no tumor at all. For example, adenoid melanoma can be misconstrued as adenocarcinoma, and desmoplastic melanoma can be misconstrued as scar.

After the correct diagnosis was established, should one write down the subtype, variant or rare features of a tumor in the report? Given the risk of make the report verbose, I prefer not to do that, unless they are important for clinicopathological correlation, therapeutic decision making, or behavior prediction.

In regard to the two melanoma variants cited above, adenoid melanoma does not imply any difference from the most common types of melanoma. As a matter of fact, it's nothing more than a histological detail for microscopic diagnosis purposes only, and the inclusion of the adjective 'adenoid' in the report may be a source of confusion for clinicians.

Conversely, desmoplastic melanoma meets the requirements laid down by me since its typical gross presentation is an amelanotic swelling that hardly is considered clinically a melanoma, hence microscopic diagnosis of melanoma could provoke strangeness without the adjective 'desmoplastic'. Moreover, desmoplastic melanomas are associated with increased recurrences in comparison to non-desmoplastic melanomas.

Maintaining coherence, I use to report basal cell carcinoma as superficial, nodular or infiltrative, despite dozens of subtypes and variants described in the medical literature. I think this simplified reporting system enables appropriate clinicopathological correlation and stratification of patients at low and high-risk for recurrence.

Likewise, when I report common melanocytic nevi, I use to banish those descriptive adjectives 'junctional', 'compound' and 'intradermal'. I prefer to sign them out as flat nevus, Miescher nevus and Unna nevus because I judge them much easier to correlate with clinical attributes of the lesion and its dermatoscopic findings.

I know that some pathologists use to write reports as if they would be revised by other pathologist, but in fact our reports, as a rule, will be read and evaluated by clinicians aiming the benefit of patients.