Up to 30% of colorectal cancers develop from sessile serrated polyps via the serrated neoplasia pathway. The clinical management of these lesions is challenging for both endoscopists and pathologists due to the difficulties in detection and recognition. As a result, more than half of all colonoscopy interval cancers, cancers detected after colonoscopy and before the next scheduled surveillance procedure, appear to develop from sessile serrated polyps. We describe the pitfalls in the clinical management of these lesions as well as potential solutions, illustrated by case reports of two patients, aged 28 and 65 years, with serrated polyposis syndrome and colorectal cancer.