Introduction: Leishmaniasis represents one of the most dangerous neglected tropical diseases. The parasite used to show a well-defined geographical distribution; however, during the last decade the parasite has spread into new areas. This change in the worldwide distribution of the parasite and in leishmaniasis epidemiology is the result of man's ill-considered interventions in the environment and of the consequent global warming.Areas covered: The present review focuses on Leishmaniasis incidence in the Mediterranean basin and underlines the pressing need to raise awareness toward the real burden of the disease in the European region. The research was undertaken using Pubmed and including all studies up to January 2020.Expert opinion: Environmental and climatic transformations have allowed the shifting northward of sand fly European geographical distribution, affecting areas traditionally considered as Leishmania-free, including Northern Italy, Germany, and even Belgium. The large-scale migration from the Middle East and Africa to Europe, and particularly to Italy for its central position in the Mediterranean basin, represents an additional and critical risk factor for the spread not only of leishmaniasis but also of other potentially life-threatening diseases. These factors highlight how the current epidemiological European scenario could drastically evolve in the next future.