The scanning tunneling microscope (STM) is a pivotal instrument that integrates the capabilities of atomic-scale measurement, characterization, and fabrication. It simultaneously fulfills the three core requirements of atomic-scale manufacturing: "visualization," "precision measurement," and "fabrication feasibility." Atomic-scale manufacturing aims for precise manipulation at the spatial scale of meters, with associated electronic dynamics occurring on ultrafast timescales ranging from femtoseconds to attoseconds. With its high spatiotemporal resolution, STM serves as a key experimental technique for revealing physical mechanisms and quantum effects at the atomic scale, significantly advancing the field from fundamental exploration to practical application. Based on the unique quantum tunneling effect, STM performs precise measurements of physical properties (e.g., electronic and magnetic) in fabricated structures. This establishes quantitative structure-property relationships between fabrication parameters and device performance,thereby providing a critical basis for process optimization and quality assessment. Furthermore, STM possesses the inherent ability for precise atomic-scale manipulation. The deep integration of STM with high-throughput and automation technologies is emerging as a core pathway to transition STM-based atomic-scale manufacturing from laboratory proof-of-concept to industrial application. This review summarizes the current research progress in the application of STM for atomic-scale measurement, characterization, and manufacturing, outlines existing challenges, and provides perspectives on future development trends.