A significant As anomaly has been reported in the literature for stream sediments and unlithified Quaternary deposits of the Pecora River valley in Southern Tuscany, extending from the “Colline Metallifere” pyrite-base metals district to the Tyrrhenian Sea. The As anomaly spreads over several square kilometers around a core that exceeds 500 ppm. Several source contributions (from natural to anthropogenic) have been invoked to explain the observed As distribution in the Pecora Valley, including the metal-working industry which was active in this area, particularly in Etrusco-Roman times and in the Middle Ages. In order to evaluate the contribution of ancient mining and metallurgical activities in the Pecora Valley to elevated As concentrations in the environment, a detailed mineralogical and geochemical survey of metallurgical slags and smelted ore minerals was undertaken from six different sites through the Pecora Valley: Poggio Butelli (Etrusco-Roman iron slags); Sata Creek, Arialla, Marsiliana, Forra and Cascata sites (all Medieval base metals slags). The As content of Etrusco-Roman slags is relatively low (few tens of ppm), whereas Medieval slags show variable, but higher amounts of base metals (±Ag) (ranging from tens to tens of thousands ppm) and As (up to 267 ppm, with average contents of about 40 ppm). Arsenic is mostly partitioned in sulfides disseminated through the glassy groundmass rather than in solid solution with the glassy matrix. Remnants of the ore used for base metal and Ag smelting during the Middle Ages had the highest As contents (up to about 1000 ppm).