Purpose of review To review recent original data on leptomeningeal metastases in patients with solid cancer. Recent findings Lung and breast cancer as well as melanoma remain the most common primaries. Advanced cytological methods and targeted sequencing for candidate tumor-specific mutations may improve the sensitivity of cerebrospinal fluid diagnostics in leptomeningeal metastases. Targeted treatments like epidermal growth factor receptor tyrosine kinase inhibitors for non-small cell lung cancer, anti-human epidermal growth factor receptor-2 treatments for breast cancer or B-rapidly accelerated fibrosarcoma-targeted or immunotherapy for melanoma have an emerging role in the management of this condition. Summary Novel diagnostic approaches and the introduction of targeted agents may improve the clinical management of patients with leptomeningeal metastases from solid cancers.