Over the last years, issues concerning diatom teratological forms and environmental stress have received growing interest within the scientific community. Publications on this topic dated back to 1890 and were summarized in a review published in 2009 by the journal Hydrobiologia, accounting for high citation rates (i.e. 117 citations Scopus and 232 citations Google Scholar, October 2020). This wide interest stimulates the authors to further unravel teratological forms significance in the light of the most recent publications (2010–2020). Diatom teratological forms are one of the best individual-level biomarkers since they provide a rapid response to several environmental stressors, including new emerging pollutants. The mechanisms involved in teratological valve likely involve both cytoskeleton and silicon metabolic pathway impairments. However, teratologies do not seem to weaken the reproduction capacity and viability of the affected individuals. We recognized eight types of teratologies as involving different parts of the valve, depending on genus. In order to summarize the information obtained by several years of research, we suggest a four-step procedure aimed at providing a theoretical pathway that researchers should follow to better explain results obtained in next-future studies and representing a starting point for the development of an environmental index based on teratological forms.