Cystic neoplasms of the pancreas account for about 10% of pancreatic tumors. Intraductal papillary mucinous neoplasms (IPMNs) are the most common cystic tumors of the pancreas presenting with no or unspecific clinical symptoms. Diagnosis of IPMNs is challenging and accomplished by CT, MRI, MRCP and EUS. Primarily, IPMNs are regarded as benign cystic lesions, however, almost 60% of resected IPMNs reveal malignant or invasive growth. The risk to progress to malignancy varies between 20-90% strongly depending on the origin of the lesion (main-duct type, branch-duct type) and clinico-pathological characteristics. Recently, first standardized algorithms for the treatment of IPMNs have been formulated, however, therapeutic consequences (surgical approach vs. surveillance strategy) are still controversial. This review provides a detailed overview of the currently discussed options for diagnostics, therapy and surveillance of IPMNs.