[Update renal cell carcinoma : Guideline update on small renal masses].

Small renal masses (kidney tumors < 4 cm) are benign in up to 30% of cases and often exhibit slow growth, yet they are still frequently primarily managed by surgery. A tumor biopsy should be performed before initiating active surveillance. As up to 8% of renal tumors could have a hereditary component, risk factors such as a diagnosis before the age of 47 years old, bilateral or multifocal lesions and syndrome-associated extrarenal manifestations, should be systematically assessed and clarified by a genetic evaluation. In patients with clear cell renal cell carcinoma and intermediate-high or high recurrence risk, as well as in metastatic with no evidence of disease (MINED) cases, adjuvant treatment with pembrolizumab can be recommended.