Background: Malignant ovarian germ cell tumours (GCT) are rare tumours with clinical and histological heterogeneity. Risk adapted treatment of these tumours is advocated. Methods: We reviewed patients with malignant ovarian GCT managed by a single specialist during 1991-2009 at our institution. Clinicopathological features that may predict behaviour of the disease and disease outcomes were assessed. Results: Thirty-four patients with a median follow-up time of 5.7 years were identified. The 10-year estimated survival rates were up to 80%; 8/13 patients with Stage I disease were recommended active surveillance, of whom three relapsed and, one with an immature teratoma died. Conclusions: Ovarian GCT are potentially curable but appear to have a worse prognosis than their testicular counterparts. To improve expertise in the management of these complex tumours and optimise future management, a supra-regional service modeled on that used in the management of gestational trophoblastic disease is proposed.