Metal nanoclusters (NCs) are promising alternatives to organic dyes and quantum dots. These NCs exhibit unique physical and chemical properties, such as fluorescence, chirality, magnetism and catalysis, which contribute to significant advancements in biosensing, biomedical diagnostics and therapy. Through adjustments in composition, size, chemical environments and surface ligands, it is possible to create NCs with tunable optoelectronic and catalytic activity. This review focuses on the integration of aptamers with metal NCs, detailing molecular detection strategies that utilise the effect of aptamers on optical signal emission of metal NC-based biosensing systems. This review also highlights recent advancements in biosensing and biomedical applications, as well as illustrative case studies. To conclude, the strengths, limitations, current challenges and prospects for metal NC-based systems were examined.