The site, extent, soft tissue extension and presence of pathologic fracture must be carefully evaluated before surgery using plain x-ray, CT scan and/ or MRI. Choice between different treatment modalities depends on the preoperative evaluation. Resection is recommended for stage IB extremely large lesions, significant pathologic fracture, and in cases where resection results in no significant morbidity as proximal fibula and flat bones. Cryosurgery is a powerful surgical adjuvant as evidenced by the lower incidence of local recurrence, whereas PMMA alone probably does not provide adequate tumor control. The main role of PMMA is to provide immediate fixation and stabilize large defects, especially in the weight bearing bones. The use of mechanical burr, in addition to simple curettage to remove the reactive sclerotic cavity is strongly recommended. Amputation is preserved for massive recurrence, malignant transformation and infection.