Unlike many malignancies, gallbladder cancer is often diagnosed incidentally, which disrupts the usual approach to staging and complicates management, both in the intraoperative and postoperative settings. Although incidental gallbladder cancer is commonly diagnosed at early stages, this malignancy is aggressive with a generally poor prognosis. As such, this entity demands familiarity with the disease and careful attention to oncologic principles. In this chapter, we discuss the management of incidental gallbladder carcinoma, including the staging, surgical approaches, and controversies inherent to this challenging, yet relatively common, scenario.