In vivo cellular imaging and in vitro assays or sensors are fundamentally used to study the spatiotemporal interaction of molecules at biological interfaces. The study of these interfaces informs various applications such as diagnostics/detection of foreign materials or processes in the biological system. Raman spectroscopy, an optical, non-destructive, label-free fingerprinting tool offers a wide array of applications in both in vitro and in vivo diagnostics owing to its relatively short acquisition time, non-invasiveness and ability to provide biochemical molecular information. It has been explored in tissue imaging, in vitro diagnosis, DNA/RNA analysis, metabolic accretions, single cell analysis photodynamic therapy, etc. The chapter details the application of the optical Raman platform in the detection and imaging of diseases/tissues. The challenges associated with SERS applications and the future outlook as a biomedical diagnostic tool are also discussed.