A pancreatic cystic lesion (PCL) is a collection of fluid in the pancreas, which is often diagnosed incidentally during abdominal imaging, and often poses a diagnostic and therapeutic challenge. PCLs not only have diverse histological and imaging appearances but also differ in clinical presentation, biologic behaviour, growth pattern, and risk of malignancy. Apart from their diagnosis, the management of PCL is also multifactorial, which takes into consideration risk of malignancy, cost of cyst analysis, cyst surveillance, anatomic location of the cyst, the patient’s age, and overall health status. Although guidelines exist for surgical and conservative management, each case needs to be tailored to malignant risk, surgical risk, and life expectancy in mind. This would thereby reduce both the monetary and non-monetary burden on patients. In this review, we aim to provide insight into the various recent advances in the diagnosis and management of PCL.