Itch represents a common and significant source of morbidity in the oncological setting. Itch sometimes can be associated with an underlying malignancy, most commonly leukemia or lymphoma. Alternatively, itch may present secondary to malignant invasion causing hepatic or renal dysfunction. Finally, itch may be related to therapeutic regimens for the underlying malignancy. This article seeks to review the clinical scenarios in which itch affects the oncological patient, to briefly present the latest understanding of the molecular and cellular mechanisms of malignancy-related itch, and to review currently available therapeutic options.