The solitary pulmonary nodule on chest X-ray (CXR) is a common problem in pulmonary medicine. Its presence raises the question of lung cancer. As five-year survival after resection of a solitary bronchogenic carcinoma can be as high as 80%, prompt evaluation is crucial. This should begin with a cancer risk assessment based on clinical and radiographic factors. The risk and benefits of surgery should next be assessed, and together with the patient's preferences, a management plan can be decided upon. Surgery is recommended for patients at high risk of malignancy with a low surgical risk, while careful observation is adopted for patients at low risk of malignancy coupled with a high surgical risk. Further diagnostic tests may be warranted to aid in this decision process. Although CXR is not useful for lung cancer screening, low-dose computed tomography imaging is increasingly recommended for individuals at high risk for lung cancer.