Testicular microlithiasis (TM) has been reported in up to 46% of men with testicular cancer. This has given rise to the suspicion that TM is a premalignant condition. In studies of healthy men there is, however, no association between TM and development of cancer. Nonetheless, patients with TM and contralateral testicular cancer, testicular atrophy, inhomogeneous parenchyma, infertility or a history of maldescensus are at increased risk of having carcinoma in situ (CIS) and cancer development. Men with TM and one or more of the above mentioned risk factors should be offered a testicular biopsy to rule out CIS.