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The management of benign ovarian lesions in girls is currently a controversial topic in the pediatric surgical literature. The purpose of this review is to highlight the epidemiology of benign ovarian masses, outline preoperative risk stratification strategies, review the indications and importance of ovary-sparing surgery (OSS), and discuss the impact of management algorithms.Efforts across the United States and Canada to promote OSS have improved awareness about the role and safety of OSS for the management of benign ovarian masses in pediatric and adolescent girls. Preoperative risk stratification techniques by a multidisciplinary team can improve the preoperative identification of lesions with a high likelihood of benign disease.Avoiding oophorectomy may be associated with a number of benefits to individual patients and the overall population. The implementation of a management algorithm to guide the treatment of pediatric and adolescent girls with ovarian lesions can reduce the rate of inappropriate oophorectomies.