Microneedle-based delivery systems have emerged as a groundbreaking technology in the realm of targeted cancer therapy. By facilitating the transdermal administration of therapeutic agents, microneedles offer a minimally invasive method to overcome the limitations posed by conventional drug delivery systems. This review comprehensively examines the potential of microneedles to enhance drug bioavailability, improve therapeutic outcomes, and reduce systemic toxicity. We explore the diverse applications of MNs in cancer treatment, including their use in chemotherapy, where MNs enable direct delivery of chemotherapeutic agents to tumor sites, thus maximizing drug efficacy and minimizing adverse effects. Additionally, we discuss the role of MNs in immunotherapy, highlighting how they can be used to deliver immune-modulating agents that activate localized immune responses against cancer cells. Furthermore, the potential of microneedles in gene therapy is addressed, emphasizing their ability to deliver genetic material directly to tumor cells, thereby offering a novel approach to cancer treatment. The review also delves into the challenges associated with MN-based therapies, such as ensuring consistent and controlled drug delivery, addressing patient variability, and overcoming manufacturing and scalability issues. Despite these challenges, the advancements in microneedle technology and the promising results from preclinical and clinical studies underscore their transformative potential in cancer therapy. We emphasize the need for further research and clinical trials to validate the efficacy and safety of microneedles.