Exosomes derived from mesenchymal and adipose-derived stem cells exhibit potent regenerative capabilities, enhancing wound healing, reducing inflammation, and improving extracellular matrix remodeling through their cargo of bioactive proteins, lipids, and nucleic acids. This comprehensive review spanning 2020-2025 reveals therapeutic benefits across chronic wounds, inflammatory skin conditions, and treatment-related skin toxicities. However, the research exposes a critical duality: while these nanosized vesicles promote tissue repair, they can simultaneously contribute to tumor progression depending on their cellular origin. This dual nature represents a significant clinical challenge that current exosome research has inadequately addressed. The field remains largely confined to preclinical studies, with clinical translation hampered by fundamental issues in standardization and manufacturing scalability. Unlike conventional cell therapies, exosome treatments offer the advantage of being cell-free, potentially reducing immunogenic risks while maintaining therapeutic potency. Yet the oncological safety profile remains poorly understood, particularly regarding long-term effects and dosing protocols. The emphasis on standardized manufacturing protocols and rigorous safety validation suggests the field recognizes these limitations but lacks the regulatory framework needed for widespread clinical implementation.