Coastal and maritime tourism have increasing negative environmental externalities, mainly due to the air, water and waste pollution and the direct and induced land-use change in urban, rural and natural spaces. At the same time this type of activity is highly dependent on the health of natural ecosystems, which provide much of the attractiveness of the Mediterranean region. Focusing on the Mediterranean Sea, this report highlights the opportunities to apply the Ecosystem (based) Approach (EcAp or EBA) for a better environmental management of coastal and marine tourism. This study is part of a global initiative to improve the Governance of Coastal and Marine Tourism around the Regional Seas. This study is an extension of the flagship report Towards a Sustainable Blue Economy published in 2019 that provided an exhaustive assessment of the environmental, social and economic impacts of the Coastal and Maritime tourism around the world.