A review of the last 399 years (1624–2023) on fin whales (Balaenoptera physalus) in the Mediterranean Sea was conducted, based on an extensive compilation of records published in the scientific literature, technical reports, public databases, journals, and social media. A total of 10,716 sightings and 575 mortality events have been computed, analysed by semesters and mapped in order to compare the summer–winter seasons especially and their implications on migration–residence. Visual and acoustic detections, feedings, migrations, primary production areas (chlorophyll), threats and causes of death and their relations have been addressed, and a mini-review on heavy metals and pollutants has been carried out on fin whales in the Mediterranean Sea. Mortality events were most frequent between November and April, coinciding with the decreased sighting period. Ship strikes posed the greatest threat, peaking between May and October, when marine traffic tends to increase in the Mediterranean Sea. Two populations coexist in the Mediterranean Sea, one resident and the other migratory, the latter using the Strait of Gibraltar for its biannual movements. Two areas with a presence of calves (up to 7 m in length) between October and February were detected: one scattered in the northern Mediterranean and the Strait of Gibraltar and its surroundings. A critical zone for collisions has been established according to the results for fin whales in the Mediterranean Sea.