Recently, small hepatocellular carcinoma (HCC) has been detected by following up patients with chronic liver diseases using ultrasonography (US). Most of the HCC patients have liver cirrhosis, and multinodular lesions are often found, even in cases of small HCC. Thus, surgical resection for small HCC is of limited efficacy. Our follow-up study indicated that a recurrent lesion was observed in 96.1% of small HCC cases after successful percutaneous ethanol injection therapy (PEIT). It is therefore very important to follow-up patients initially treated with PEIT with US for the detection of newly developed tumor nodules, because of the multicentric nature of HCC. A recurrence is subsequently again treated with PEIT. The 5-year survival rate of our 250 small HCC cases treated by PEIT is 46.7%. However, cases not followed by regular US after the first PEIT show significantly poorer 5-year survival rates. In future, it would appear to be of importance to search for means to inhibit or prevent recurrence.