In the past five years, technological advances in the field of precision medicine in oncology have led to the emergence of a number of commercially available services for tumor profiling. There is an increased acceptance of these services that can help in finding treatment options based on molecular alterations as individual case reports have shown outstanding response to targeted therapies. Tumor profiling must seek to augment, rather than replace, existing local testing with the objective of helping more patients to find appropriate treatment options. The opportunity has arrived to integrate these services into the clinical setting, specifically in cases of refractory and rare tumors. The promise of precision medicine is clear but conclusive demonstration of how each of the different services delivers on the promise is not uniformly forthcoming. The selection of which service is most appropriate must be based on demonstrated analytical validation, quality standards, and data on clinical benefit and utility. The aims of this paper are to evaluate three tumor tissue profiling services commercially available and to propose to the physician how molecular profiling information can be used in clinical treatment decisions today.