Abstract: Optical coherence tomography (OCT) is an emerging imaging technology characterized by its non-invasiveness, rapid acquisition, and real-time capabilities. With a resolution and penetration depth intermediate between high-frequency ultrasound and reflectance confocal microscopy, OCT has garnered increasing attention in dermatology. Recent technological advancements have further enhanced OCT systems, achieving subcellular-level resolution and enabling characteristic visualization of microvascular networks and other fine structures, thereby significantly expanding its applications in dermatological practice. This article provides a systematic review of the application progress of OCT technology in the diagnosis and evaluation of various benign and malignant skin tumors. Special emphasis is placed on its clinical utility in melanocytic nevi and melanoma, basal cell carcinoma, squamous cell carcinoma, adnexal tumors, hemangiomas, and lymphomas. The review aims to offer theoretical foundations and technical references for future research and clinical applications in this field.