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Introduction: Pleomorphic adenoma is the most common salivary gland tumor, which usually involves the parotid gland. It can seldom undergo malignant transformation. Therefore, the best treatment to avoid malignant transformation is to excise the tumor, which is a straightforward decision in young and fit patients. However, surgery under general anaesthesia can lead to a rapid postoperative cognitive impairment in the elderly patients. Also, some patients may be at a higher risk for a general anaesthetic due to their general health and associated medical conditions. Aim: To discuss the advantages and disadvantages of surgical versus non-surgical management of parotid pleomorphic adenomas in the elderly and medically compromised. Methods and Material: A review of English literature. Conclusion: A decision to excise a parotid pleomorphic adenoma, with no malignant pointers, in the elderly and in patients who are high risk for general anaesthesia should be taken cautiously and a non-surgical approach should be considered. [Arch Clin Exp Surg 2012; 1(1.000): 41-44]