FAO has promoted the ecosystem approach to fisheries (EAF) as an appropriate framework for the sustainable development and management of fisheries worldwide. With a view to contribute to the identification of lessons and good practices for EAF implementation, this publication documents nine case studies that attempted to put into practice some of the key principles and tools of the approach in the Mediterranean Sea. The case studies were selected to cover a broad range of contexts including small scale and industrial fisheries operating at local, national and sub-regional scales. It was not within the scope of the publication to evaluate the level of implementation of the ecosystem approach. A specific tool for monitoring implementation is proposed and exemplified. Case studies were analysed with a view to draw preliminary lessons regarding the enabling factors that facilitated the progress made as well as the challenges faced in the transition towards EAF-based management systems. Attention is drawn to key enabling conditions such as favourable policies, legislation and regulatory frameworks, the existence of regional mechanisms for cooperation, favourable market dynamics and social processes, and the relatively low complexity of the fishery systems analysed. A set of factors emerged that contributed to progress during implementation, such as the clear definition of fishing rights, the enhancement of mechanisms for compliance, scientific monitoring and adaptation of management measures, as well as the explicit consideration of biological and socioeconomic aspects in management actions. Further progress in the transition towards sustainable management systems is hampered by external and internal factors. External factors are related, for instance, to environmental changes, the poor regulation and control of competing sectors, consumer behaviour and the governance environment. Issues such as stakeholder representation, knowledge gaps and the availability of sustainable sources of funding are among common internal factors. The authors also discuss how slow progress in the implementation of management plans can generate discredit with the institutions and add additional challenges for any future initiatives to engage stakeholders in participatory management. The case-based results and lessons of how the ecosystem approach to fisheries was considered, developed and implemented in the fisheries discussed in this publication not only contribute to the documentation of current practices in the Mediterranean but may also guide future attempts to further develop the field