Coal tar pitch (CTP) exposure occurs in many manufacturing applications such as coke production, aluminum reduction, pipe coating, roofing and paving industries, and some nonheated processes. Pitch workers are exposed to polycyclic aromatic hydrocarbons (PAHs) emitted from CTP which cause pitch-related oculocutaneous diseases and skin cancer. Environmental factors (e.g., sunlight, humidity, and temperature) can aggravate such skin problems in workers. Pitch-related oculocutaneous diseases include photosensitivity and tar erythema, pitch melanosis, folliculitis and acne, contact dermatitis, benign papillomas, premalignant pitch keratoses and acanthomas, and malignant skin lesions. The carcinogenesis of CTP, especially PAHs, has been confirmed by laboratory experiments. Long-term exposure to CTP increases the prevalence of pitch-induced squamous cell carcinomas and basal cell carcinomas. Early biopsy and diagnosis of premalignant and malignant skin lesions are important. Prevention, such as engineering environmental controls and employee education, especially for sunlight protection and medical monitoring, will minimize or eliminate the oculocutaneous exposure to CTP and promote workers’ health.