To evaluate the effect of percutaneous ethanol injection given alone, we studied disease recurrence and prognosis in 37 patients with solitary hepatocellular carcinoma up to 2 cm. The patients were classified as Child's class A, 22; B, 11; and C, 4. During follow-up for periods ranging from 10 to 44 (mean, 26) months, 15 of the 37 patients (40.5%) had disease recurrence. The 1-, 2-, and 3-year recurrence rates were 37, 49, and 53%, respectively (Kaplan-Meier method). Significant risk factors for recurrence included the hypervascularity and the histological differentiation of the tumor (p < 0.01). Of those 15 patients, two had local recurrence, eight had nodular recurrence (fewer than two nodules), and five had widespread multinodular recurrence. The patients with local or nodular recurrence then received repeated injections of ethanol, while those with multinodular recurrence received transarterial embolization or chemolipiodolization therapy as possible. Seven of the 37 patients died during follow-up. The 1-, 2-, and 3-year survival rates were 95, 81, and 70%, respectively (Kaplan-Meier method). No factor was significant in prognosis. We observed a significant relationship between recurrence pattern and prognosis. Patients with a widespread multinodular recurrence had a significantly shorter survival (p < 0.01). In summary, ethanol injections given alone appeared to be effective in treating small and solitary hepatocellular carcinomas. Repeated injection of ethanol of the site of recurrence was useful in prolonging survival.