Tumors represent a significant threat to human health, underscoring the critical need for effective treatment strategies. However, conventional drug therapies are hampered by imprecise delivery, potentially leading to inadequate efficacy and severe side effects. The strategic development of nanomedicines is believed to harbor enormous potential for enhancing drug safety and efficacy, especially for precise, tumor-targeted therapies. Nevertheless, the fate of these nanomedicines within the human body is intricately governed by various physiological barriers and complex environments, posing challenges to predicting their behaviors. Near-infrared II (NIR-II, 1000–1700 nm) fluorescence imaging technology serves as a non-invasive, real-time monitoring method that can be applied for the precise evaluation of nanomedicine delivery in cancer therapy due to its numerous advantages, including high tissue penetration depth, high spatiotemporal resolution, and high signal-to-noise ratio. In this review, we comprehensively summarize the pivotal role of NIR-II fluorescence imaging in guiding the intratumoral precise delivery of nanomedicines and shed light on its current applications, challenges, and promising prospects in this field.