Gynecologic malignancies are rare in the pediatric and adolescent populations. Given the potential consequence of infertility and the negative impact on body image that can result from the treatment of these cancers, clinicians must be aware of the most current recommendations for medical and surgical therapy of gynecologic malignancies in these patients. This article focuses on the most common gynecologic cancers in pediatric and adolescent girls, with a special emphasis on treatment that maintain fertility and positive body image.