There is a growing body of literature on the role of beta-carotene and other carotenoids in human chronic diseases, including cancer. While epidemiological evidence shows that a high dietary intake of fruits and vegetables rich in carotenoids is associated with a reduced risk for cancer, results from intervention trials indicate that supplemental beta-carotene enhances the risk of developing lung cancer incidence and mortality among smokers. A possible mechanism which can explain the dual role of carotenoids as both beneficial and harmful agents in cancer is that their excess or deficiency may bring about changes in molecular pathways involved in apoptotic signalling. Carotenoid ability in inhibiting or in enhancing apoptosis depends on several factors: carotenoid concentration, concerted action of multiple micronutrients, cell type, and redox status. This review summarizes the available evidence for a modulatory action of carotenoids on apoptosis and focuses on the main molecular pathways involved in this process.