Purpose of Review <p>Lung transplantation remains a life-saving intervention for many patients with end-stage lung disease. Given scarcity of donor organs, candidacy evaluation of potential recipients entails an extremely detailed assessment where history of malignancy, at least traditionally, was considered a contraindication. This review details the evolution of recommendations surrounding transplant candidates with pre-existing cancers, explores the complex interplay between predicting cancer risk and weighing it against transplantation benefit, and highlights the existing data on cancer-related outcomes in lung transplant recipients.</p> Recent Findings <p>Advancements in cancer screening, diagnostics, surveillance tools, and treatments have led to a greater number of patients with oncologic history being considered for transplantation. Current expert opinion consensus documents underscore the critical importance of a rigorous evaluation focused on assessing the specific type and stage of pre-existing malignancy and extrapolating risk of recurrence into required disease-free intervals prior to listing.</p> Summary <p>Contemporary practice in eligibility evaluation of patients with pre-transplant malignancies now involves a highly nuanced and meticulously comprehensive approach, balancing the imperative to extend life through transplantation against the inherent risks of cancer recurrence.</p>