DOI: https://doi.org/10.36347/sasjs.2026.v12i04.011

Pages: 304-311

Renal cell carcinoma (RCC) has shown a steady increase in incidence over the past three decades, largely attributed to the widespread use of cross-sectional imaging modalities such as computed tomography (CT) and magnetic resonance imaging (MRI). As a result, small renal masses (SRMs), defined as contrast-enhancing renal tumors ≤ 4 cm in diameter, are now detected with increasing frequency and represent up to two-thirds of newly diagnosed renal tumors. SRMs constitute a biologically heterogeneous group of lesions. While many are malignant, a substantial proportion are benign or indolent tumors with limited metastatic potential. This biological variability has significantly influenced management strategies, shifting the paradigm from routine radical nephrectomy to more individualized approaches including active surveillance, nephron-sparing surgery, and minimally invasive ablative therapies. This review aims to provide an updated overview of the epidemiology, pathology, natural history, diagnostic evaluation, and contemporary management strategies for small renal masses. A literature search was conducted using major medical databases including PubMed, Scopus, and Web of Science. Articles published in English focusing on small renal masses, their epidemiology, natural history, diagnostic evaluation, and management strategies were reviewed. Priority was given to recent systematic reviews, prospective studies, and current clinical guidelines.