This study critically reviews 91 peer-reviewed publications assessing the sustainability of Mediterranean tourism destinations through indicator-based frameworks. Using the Scopus database, studies were selected based on defined keywords, geographical scope, and inclusion/exclusion criteria. Data were systematically coded across multiple dimensions including methodological approaches, indicator categories, sustainability dimensions, thematic focus, stakeholder involvement, and data sources. Findings reveal a dominance of quantitative methods, particularly composite indices, multi-criteria decision-making, and GIS-based analysis. Environmental indicators—addressing water management, waste, pollution, and carrying capacity—are most prevalent, followed by economic measures of employment and revenue. Social and governance dimensions remain underrepresented. Research is geographically concentrated in Spain, Greece, and Italy, with limited coverage of North African and Eastern Mediterranean contexts. The review highlights gaps in geographic representation, dimension balance, and indicator standardization. Addressing these will require integrated frameworks, stronger stakeholder engagement, and innovative data collection methods. The findings provide guidance for developing robust, comparable, and context-specific sustainability assessment tools for the Mediterranean region.