Europe is characterized by an uneven record of Middle Paleolithic occupations. Specifically, large parts of southeastern Europe display markedly lower site densities and less intensive evidence of human presence than is found elsewhere; this has often resulted in the exclusion of the Balkans from debates related to Pleistocene human adaptation. The discrepancy stems either from the lower population densities of southeastern Europe or an imbalance in research across Europe. Additionally, our understanding of Balkan Middle Paleolithic stone tool industries suffers from the use of Mousterian labels defined when Bordian typology was the chief method of lithic analysis. Industrial facies then defined and still in use include Balkan Charentian, Levallois Mousterian, Micromousterian, Denticulate Mousterian; their relation with the rest of the Eurasian record was and remains unclear. This paper sets aside the issue of scarcity of Pleistocene occupations and tries to address Neanderthal biogeography, and variations in Neanderthal technological behavior and subsistence, based on the available record. It reviews the current Middle Paleolithic record in the Balkans, presents the apparent temporal and spatial trends, and presents the provisional biogeography of hominins, including scenarios for the demise of Neanderthals at or soon after the arrival of modern humans in Europe. The paper ends with a discussion of perspectives for future research arising from this analysis of the available record and proposes some hypotheses regarding the role of the Balkans in the overall context of the occupational history of western Eurasia in the Middle/Late Pleistocene.