With about 11,100 islands and islets of which ca. 250 are regularly inhabited by human, the Mediterranean Sea represents one of the regions of the world with the most islands and archipelagos. These numerous islands represent a significant component of the Mediterranean biodiversity, notably with the presence of range-restricted species and peculiar vegetation types. The aim of this review is to provide a balanced view of this highly diverse phytoecological heritage, but also taking into account the medium sized islands and the smaller ones that have not been highlighted so far. Mediterranean islands constitute both a museum for ancient lineages (paleoendemic taxa) and cradle for recent plant diversification. The complex historical biogeography (paleogeographical events of the Neogene, Messinian salinity crisis, climatic and eustatic changes of the Pleistocene, influence of glacial events) has profoundly influenced the current patterns of plant diversity. These insular landscapes were also precociously impacted by prehistoric man, possibly by Neanderthals. Among the 157 large Mediterranean islands (i.e. with a surface area exceeding 10 km 2), 49 have a surface greater than 100 km 2 .The main patterns anddynamics of vegetationon the largests islands (Balearic Islands, Corsica, Sardinia, Sicily, Croatian islands, Greek islands, Crete, Cyprus) are summarized. Then, the specific ecosystem functioning (disturbance, plant-animal interactions) and vegetation structures of the small Mediterranean islands (i.e. a surface area less than 10 km 2 or 1000 ha), are highlighted by evoking successively the small rocky islands, the volcanic ones, and the sandy and flat islands. Owing to their uniqueness and fragility, Mediterranean islands urgently need some integrated and ambitious conservation planning, aiming at the long-term preservation of their outstanding biotic and cultural heritage.