Many diseases as atherosclerosis and metabolic dysfunctions are known to correlate with changes of the lipid profile of tissues and body fluids. Therefore, the importance of reliable methods of lipid analysis is obvious. Although matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF MS) was so far primarily used for protein analysis, this method has itself proven to be very useful in lipid analysis, too. This review provides an overview of applications of MALDI-TOF MS in lipid analysis and summarizes the specific advantages and drawbacks of this modern soft-ionization method. The focus will be on the analysis of body fluids and cells as well as the diagnostic potential of the method in the lipid field. It will be shown that MALDI-TOF mass spectra can be recorded in a very short time and provide important information on the lipid as well as the fatty acyl composition of the lipids of an unknown sample. However, it will also be shown that only selected lipid classes (in particular those with quaternary ammonia groups as phosphatidylcholine) are detected if crude mixtures are analyzed as they are more sensitively detectable than other ones. This review ends with a short outlook emphasizing current methodological developments.