Background: Altered miRNA expression is an early event upon exposure to occupational/environmental carcinogens; thus, identification of a novel asbestos-related profile of miRNAs able to distinguish asbestos-induced cancer from cancer with different etiology can be useful for diagnosis. We therefore performed a study to identify miRNAs associated with asbestos-induced malignancies.Methods: Four groups of patients were included in the study, including patients with asbestos-related (NSCLC Asb ) and asbestos-unrelated non-small cell lung cancer (NSCLC) or with malignant pleural mesothelioma (MPM), and diseasefree subjects (CTRL). The selected miRNAs were evaluated in asbestos-exposed population.Results: Four serum miRNAs, that is miR-126, miR-205, miR-222, and miR-520g, were found to be implicated in asbestos-related malignant diseases. Notably, increased expression of miR-126 and miR-222 were found in asbestosexposed subjects, and both miRNAs are involved in major pathways linked to cancer development. Epigenetic changes and cancer-stroma cross-talk could induce repression of miR-126 to facilitate tumor formation, angiogenesis, and invasion.Conclusions: This study indicates that miRNAs are potentially involved in asbestos-related malignancies, and their expression outlines mechanism(s) whereby miRNAs may be involved in an asbestos-induced pathogenesis.Impact: The discovery of a miRNA panel for asbestosrelated malignancies would impact on occupational compensation and may be utilized for screening asbestos-exposed populations. Analysis and interpretation of data (e.g., statistical analysis, biostatistics, computational analysis): L. Santarelli, S. Gaetani, M. Valentino, J. Neuzil, M. Tomasetti, M. Bovenzi Writing, review, and/or revision of the manuscript: M. Comar, J. Neuzil, M. Tomasetti, M. Bovenzi Study supervision: L. Santarelli, M. Bovenzi Other (WHO classification of lung tumors): C. Rubini