PURPOSE OF REVIEW: To analyze the current literature regarding incidental finding of renal cell carcinoma (RCC). RECENT FINDINGS: RCC incidence rates continue to rise among all racial, age, tumour size categories, with the most rapid increase for localized disease and small tumours. In parallel, it seems that mortality from RCC decreases in all these groups. Computed tomography guided tumour biopsies are gaining more accuracy and acceptance, whereas minimal invasive treatments such as cryoablation or radiofrequency ablation are competing with nephron-sparing surgery in certain patient categories. Finally, active surveillance is emerging as a new management modality for elderly patients with small renal masses. SUMMARY: The emergence of incidental diagnosis of renal tumours which is related to the widespread use of imaging has played a pivotal role in the increased incidence of RCC and therefore potentially in improving survival in localized disease. However, a significant proportion of treated tumours are benign or undetermined and active surveillance has proven safe in selected patients. There is the risk in widening the treatment armamentarium that a certain number of patients are overtreated. In conclusion, accurate tools are needed for a proper selection of patients with incidentally detected tumours, so that they can benefit from nephron-sparing surgery, ablative therapies or observation.