Nanocomposite hydrogel microneedles represent a promising theranostic platform for personalized cancer treatment. These microneedles combine diagnostic and therapeutic functions, enabling targeted drug delivery, real-time monitoring, and enhanced patient compliance. Unlike traditional methods, they offer a minimally invasive approach with improved drug permeability, reduced toxicity, and better patient acceptance. Hydrogel microneedles (HFMs) are particularly advantageous due to their biocompatibility, tunable properties, and ability to deliver both small molecules and macromolecules, including nanoparticles (NPs) for enhanced therapeutic and diagnostic capabilities. HFMs can be fabricated using various materials, including synthetic and natural polymers, and their design can be tailored for different applications. The integration of NPs into HFMs enhances their functionality, enabling synergistic effects such as controlled drug release, photothermal therapy, and targeted cancer cell destruction. The combination of NPs and hydrogels allows for the development of smart systems that respond to external stimuli, improving drug delivery efficiency and therapeutic outcomes. Despite their potential, challenges remain in the synthesis, in vivo application, and long-term stability of nanocomposite HFMs. Issues such as controlled degradation, NP distribution, and biocompatibility must be addressed to ensure safe and effective treatment. Future research should focus on optimizing fabrication methods, enhancing NP-hydrogel interactions, and improving the integration of multiple functions into a single platform. The development of advanced HFMs holds great promise for revolutionizing cancer therapy by offering more precise, personalized, and efficient treatment options.Nanocomposite hydrogel microneedles represent a promising theranostic platform for personalized cancer treatment. These microneedles combine diagnostic and therapeutic functions, enabling targeted drug delivery, real-time monitoring, and enhanced patient compliance. Unlike traditional methods, they offer a minimally invasive approach with improved drug permeability, reduced toxicity, and better patient acceptance. Hydrogel microneedles (HFMs) are particularly advantageous due to their biocompatibility, tunable properties, and ability to deliver both small molecules and macromolecules, including nanoparticles (NPs) for enhanced therapeutic and diagnostic capabilities. HFMs can be fabricated using various materials, including synthetic and natural polymers, and their design can be tailored for different applications. The integration of NPs into HFMs enhances their functionality, enabling synergistic effects such as controlled drug release, photothermal therapy, and targeted cancer cell destruction. The combination of NPs and hydrogels allows for the development of smart systems that respond to external stimuli, improving drug delivery efficiency and therapeutic outcomes. Despite their potential, challenges remain in the synthesis, in vivo application, and long-term stability of nanocomposite HFMs. Issues such as controlled degradation, NP distribution, and biocompatibility must be addressed to ensure safe and effective treatment. Future research should focus on optimizing fabrication methods, enhancing NP-hydrogel interactions, and improving the integration of multiple functions into a single platform. The development of advanced HFMs holds great promise for revolutionizing cancer therapy by offering more precise, personalized, and efficient treatment options.