As principal investigator of the National Institute of Allergy and Infectious Diseases-sponsored Mycoses Study Group for the past 27 years, I have been fortunate to play a role in the many advances in the field of clinical mycology and antifungal therapy. For the Finland lecture, I will briefly discuss the development of the Mycoses Study Group, provide an overview of the currently available antifungal agents, and describe advances and lessons related to the treatment and management of cryptococcal meningitis (the most common form of fungal meningitis), 3 important endemic mycoses (namely, blastomycosis, histoplasmosis, and coccidioidomycosis), candidemia and invasive candidiasis (the most common forms of nosocomial fungal disease), and invasive aspergillosis (the most common form of invasive mould disease). My concluding remarks will address the increasing hurdles and challenges, as well as the rewards, facing investigators who focus on clinical trials. © 2006 by the Infectious Diseases Society of America. All rights reserved.