In this chapter, some special forms of the clinical and histopathological presentation of leprosy are discussed: Lucio’s leprosy and Lucio’s phenomenon, histoid leprosy, nodular leprosy of childhood, and primary neural leprosy. The main clinical and histopathological characteristics of these forms and the condition under which they appear within the entire spectrum of leprosy and its reaction phenomena are presented. In addition, the main differential clinical and pathological diagnoses of each of these lesions are discussed. The use of fine-needle aspiration cytology for the diagnosis of leprosy, including its reaction phenomena, has also been addressed. The identification of the histopathological features of these special forms of leprosy is important to confirm the clinical diagnosis for guiding treatment and preventing the possible misinterpretation of clinical and histopathological findings.