diff --git a/packages/node/src/integrations/tracing/express.ts b/packages/node/src/integrations/tracing/express.ts
index e13ce6212b79..f2f03cd53bfc 100644
--- a/packages/node/src/integrations/tracing/express.ts
+++ b/packages/node/src/integrations/tracing/express.ts
@@ -1,6 +1,6 @@
 import type * as http from 'node:http';
 import type { Span } from '@opentelemetry/api';
-import type { ExpressRequestInfo } from '@opentelemetry/instrumentation-express';
+import type { ExpressLayerType, ExpressRequestInfo } from '@opentelemetry/instrumentation-express';
 import { ExpressInstrumentation } from '@opentelemetry/instrumentation-express';
 import type { IntegrationFn } from '@sentry/core';
 import {
@@ -22,6 +22,41 @@ import { ExpressInstrumentationV5 } from './express-v5/instrumentation';
 const INTEGRATION_NAME = 'Express';
 const INTEGRATION_NAME_V5 = 'Express-V5';
 
+type IgnoreMatcher = string | RegExp | ((path: string) => boolean);
+
+interface ExpressOptions {
+  /**
+   * Ignore specific layers based on their path.
+   *
+   * Accepts an array of matchers that can be:
+   * - String: exact path match
+   * - RegExp: pattern matching
+   * - Function: custom logic that receives the path and returns boolean
+   */
+  ignoreLayers?: IgnoreMatcher[];
+  /**
+   * Ignore specific layers based on their type.
+   *
+   * Available layer types:
+   * - 'router': Express router layers
+   * - 'middleware': Express middleware layers
+   * - 'request_handler': Express request handler layers
+   *
+   * @example
+   * ```javascript
+   * // Ignore only middleware layers
+   * ignoreLayersType: ['middleware']
+   *
+   * // Ignore multiple layer types
+   * ignoreLayersType: ['middleware', 'router']
+   *
+   * // Ignore all layer types (effectively disables tracing)
+   * ignoreLayersType: ['middleware', 'router', 'request_handler']
+   * ```
+   */
+  ignoreLayersType?: ('router' | 'middleware' | 'request_handler')[];
+}
+
 function requestHook(span: Span): void {
   addOriginToSpan(span, 'auto.http.otel.express');
 
@@ -56,28 +91,32 @@ function spanNameHook(info: ExpressRequestInfo<unknown>, defaultName: string): s
 
 export const instrumentExpress = generateInstrumentOnce(
   INTEGRATION_NAME,
-  () =>
+  (options: ExpressOptions = {}) =>
     new ExpressInstrumentation({
       requestHook: span => requestHook(span),
       spanNameHook: (info, defaultName) => spanNameHook(info, defaultName),
+      ignoreLayers: options.ignoreLayers,
+      ignoreLayersType: options.ignoreLayersType as ExpressLayerType[],
     }),
 );
 
 export const instrumentExpressV5 = generateInstrumentOnce(
   INTEGRATION_NAME_V5,
-  () =>
+  (options: ExpressOptions = {}) =>
     new ExpressInstrumentationV5({
       requestHook: span => requestHook(span),
       spanNameHook: (info, defaultName) => spanNameHook(info, defaultName),
+      ignoreLayers: options.ignoreLayers,
+      ignoreLayersType: options.ignoreLayersType as ExpressLayerType[],
     }),
 );
 
-const _expressIntegration = (() => {
+const _expressIntegration = ((options: ExpressOptions = {}) => {
   return {
     name: INTEGRATION_NAME,
     setupOnce() {
-      instrumentExpress();
-      instrumentExpressV5();
+      instrumentExpress(options);
+      instrumentExpressV5(options);
     },
   };
 }) satisfies IntegrationFn;
@@ -89,6 +128,8 @@ const _expressIntegration = (() => {
  *
  * For more information, see the [express documentation](https://docs.sentry.io/platforms/javascript/guides/express/).
  *
+ * @param {ExpressOptions} options Configuration options for the Express integration.
+ *
  * @example
  * ```javascript
  * const Sentry = require('@sentry/node');
@@ -97,6 +138,34 @@ const _expressIntegration = (() => {
  *   integrations: [Sentry.expressIntegration()],
  * })
  * ```
+ *
+ * @example
+ * ```javascript
+ * // To ignore specific middleware layers by path
+ * const Sentry = require('@sentry/node');
+ *
+ * Sentry.init({
+ *   integrations: [
+ *     Sentry.expressIntegration({
+ *       ignoreLayers: ['/health', /^\/internal/]
+ *     })
+ *   ],
+ * })
+ * ```
+ *
+ * @example
+ * ```javascript
+ * // To ignore specific middleware layers by type
+ * const Sentry = require('@sentry/node');
+ *
+ * Sentry.init({
+ *   integrations: [
+ *     Sentry.expressIntegration({
+ *       ignoreLayersType: ['middleware']
+ *     })
+ *   ],
+ * })
+ * ```
  */
 export const expressIntegration = defineIntegration(_expressIntegration);
 
diff --git a/packages/node/test/integrations/tracing/express.test.ts b/packages/node/test/integrations/tracing/express.test.ts
new file mode 100644
index 000000000000..6db44c58e365
--- /dev/null
+++ b/packages/node/test/integrations/tracing/express.test.ts
@@ -0,0 +1,197 @@
+import { ExpressInstrumentation } from '@opentelemetry/instrumentation-express';
+import { type MockInstance, beforeEach, describe, expect, it, vi } from 'vitest';
+import { expressIntegration, instrumentExpress, instrumentExpressV5 } from '../../../src/integrations/tracing/express';
+import { ExpressInstrumentationV5 } from '../../../src/integrations/tracing/express-v5/instrumentation';
+import { INSTRUMENTED } from '../../../src/otel/instrument';
+
+vi.mock('@opentelemetry/instrumentation-express');
+vi.mock('../../../src/integrations/tracing/express-v5/instrumentation');
+
+describe('Express', () => {
+  beforeEach(() => {
+    vi.clearAllMocks();
+    delete INSTRUMENTED.Express;
+    delete INSTRUMENTED['Express-V5'];
+
+    (ExpressInstrumentation as unknown as MockInstance).mockImplementation(() => {
+      return {
+        setTracerProvider: () => undefined,
+        setMeterProvider: () => undefined,
+        getConfig: () => ({}),
+        setConfig: () => ({}),
+        enable: () => undefined,
+      };
+    });
+
+    (ExpressInstrumentationV5 as unknown as MockInstance).mockImplementation(() => {
+      return {
+        setTracerProvider: () => undefined,
+        setMeterProvider: () => undefined,
+        getConfig: () => ({}),
+        setConfig: () => ({}),
+        enable: () => undefined,
+      };
+    });
+  });
+
+  describe('instrumentExpress', () => {
+    it('defaults are correct for instrumentExpress', () => {
+      instrumentExpress({});
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: undefined,
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes ignoreLayers option to instrumentation', () => {
+      instrumentExpress({ ignoreLayers: ['/health', /^\/internal/] });
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: ['/health', /^\/internal/],
+        ignoreLayersType: undefined,
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes ignoreLayersType option to instrumentation', () => {
+      instrumentExpress({ ignoreLayersType: ['middleware'] });
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: ['middleware'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes multiple ignoreLayersType values to instrumentation', () => {
+      instrumentExpress({ ignoreLayersType: ['middleware', 'router'] });
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: ['middleware', 'router'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes both options to instrumentation', () => {
+      instrumentExpress({
+        ignoreLayers: ['/health'],
+        ignoreLayersType: ['request_handler'],
+      });
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: ['/health'],
+        ignoreLayersType: ['request_handler'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+  });
+
+  describe('instrumentExpressV5', () => {
+    it('defaults are correct for instrumentExpressV5', () => {
+      instrumentExpressV5({});
+
+      expect(ExpressInstrumentationV5).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentationV5).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: undefined,
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes options to instrumentExpressV5', () => {
+      instrumentExpressV5({
+        ignoreLayers: [(path: string) => path.startsWith('/admin')],
+        ignoreLayersType: ['middleware', 'router'],
+      });
+
+      expect(ExpressInstrumentationV5).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentationV5).toHaveBeenCalledWith({
+        ignoreLayers: [expect.any(Function)],
+        ignoreLayersType: ['middleware', 'router'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+  });
+
+  describe('expressIntegration', () => {
+    it('defaults are correct for expressIntegration', () => {
+      expressIntegration().setupOnce!();
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: undefined,
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+
+      expect(ExpressInstrumentationV5).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentationV5).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: undefined,
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes options from expressIntegration to both instrumentations', () => {
+      expressIntegration({
+        ignoreLayers: [/^\/api\/v1/],
+        ignoreLayersType: ['middleware'],
+      }).setupOnce!();
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: [/^\/api\/v1/],
+        ignoreLayersType: ['middleware'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+
+      expect(ExpressInstrumentationV5).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentationV5).toHaveBeenCalledWith({
+        ignoreLayers: [/^\/api\/v1/],
+        ignoreLayersType: ['middleware'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+
+    it('passes all layer types from expressIntegration to instrumentation', () => {
+      expressIntegration({
+        ignoreLayersType: ['router', 'middleware', 'request_handler'],
+      }).setupOnce!();
+
+      expect(ExpressInstrumentation).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentation).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: ['router', 'middleware', 'request_handler'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+
+      expect(ExpressInstrumentationV5).toHaveBeenCalledTimes(1);
+      expect(ExpressInstrumentationV5).toHaveBeenCalledWith({
+        ignoreLayers: undefined,
+        ignoreLayersType: ['router', 'middleware', 'request_handler'],
+        requestHook: expect.any(Function),
+        spanNameHook: expect.any(Function),
+      });
+    });
+  });
+});