Official data on the distribution, prevalence and impact of infectious diseases in Mediterranean finfish aquaculture are lacking. The absence of data on diseases has an undeniable negative impact on the efficacy of control strategies. Therefore, the aim of our systematic review was to gather data from the available literature referring to years 2010-2024 to identify the most important diseases affecting finfish of the Mediterranean Sea. Out of 9,021 articles screened, 84 papers were selected, quality assessed and summarized. The most frequently reported viral diseases were caused by Betanodaviridae followed by Iridoviridae, which are responsible for Infectious Spleen and Kidney Necrosis disease (ISKN) and Lymphocystis diseases (LCVD), respectively. Amongst bacterial pathogens, Vibrio alginolyticus, Mycobacterium marinum and Vibrio harveyi ranked at the top three with Aeromonas hydrophila, Photobacterium damselae piscicida and Vibrio vulnificus closely following. For parasitic agents, Amiloodinium ocellatum and Lernanthropus kroyeri were most reported followed by Cryptocarion irritans, Enterospora nucleophile, Ceratothoa ostreoides, Ergasilus sieboldi and Livoneca redmanni (equal merit). Many authors highlighted the increasing impact of climate change on disease outbreaks and parasite life cycles. This review also revealed significant discrepancies in the number and quality of reports from different parts of the Mediterranean, with clear evidences of underreporting in several countries, likely exacerbated by the limited availability of trained diagnostic laboratories. Consequences of diseases epidemiology on the efficacy of vaccination is also discussed. Finally, the obtained data highlight the urgent need to standardize the reporting of aquaculture-based epizootics.