Because the majority of small renal masses (SRMs; <4 cm) demonstrate low metastatic potential and can be effectively treated with radical or partial nephrectomy, the role of lymph node dissection (LND) at the time of surgery is unclear. A randomized trial demonstrated no survival benefit of LND in clinically localized renal cell carcinoma. Thus, LND is not recommended routinely for SRMs. For patients with high-risk features or radiographic evidence of lymphadenopathy, however, LND may improve local staging and potentially provide a survival benefit. If performed, a LND template should be based on the known lymphatic drainage of the kidneys.