Gangliosides--glycosphingolipids that contain sialic acid--are concentrated in plasma membrane lipid domains that are specialized for cell signaling. Recent evidence indicates that gangliosides have two different roles in cell signaling. They can act in cis to modulate tyrosine kinase receptor function and in trans as ligands for receptors that facilitate communication between cells. These signaling functions of gangliosides may be potential therapeutic targets in cancer, diabetes and nerve regeneration.