Dermoid ovarian cysts, or mature cystic teratomas, are the most common benign ovarian neoplasms found in adolescents and they continue to challenge clinicians about correct management and treatment.Laparoscopic treatment for large cysts is usually the preferred method with ovarian preservation. Cyst rupture and recurrence still remain potential risks of this surgical approach. Torsion can occur frequently in the population and when it occurs, fertility-sparing treatment should be attempted.Physicians should understand the major controversies surrounding management of dermoid cysts and the importance of preserving future fertility.