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The rupestrian habitat is a distinctive element of the Mediterranean landscape. It is made of structures excavated in the rocks and making benefit from the availability of weak rocks or the presence (in earlier period) of natural hollows and rock shelters. Typical examples are from all over the Mediterranean region, such as the sepulchral monuments and temples which date back to the years before the Christian era (Hittitian, Egyptian, Etruscan, Hellenistic Nabatean and early Christian structures) or the underground town and churches in Christian, Byzantine and medieval period (Caucasus, Anatolia, Ethiopia). Responsible institutions, as well as UNESCO, are deeply involved in programs for mitigating the risk and proposing a proper maintenance plan. In the present paper some case studies have been investigated, to show anthropological and structural similarities among them, but also geological, geomechanical and geomorphological ones. Etruscan monuments and temple of Tarquinia and Norchia (Italy), Petra and Al-Ula (Nabatean kingdom), Byzantine rupestrian Heritage in the Caucasus (Georgia) and some others, may offer a clue to understand the interconnection of Mediterranean cultures during the time. On the other hand, considering their geological and topographical properties, the main acting processes are slope instability on a rock material, that sometime shows a behavior that is at border between weak rock and stiff soil and where water and weathering may play a relevant role in their morphological evolution and future survival. In such conditions the main effort is to preserve them from an irreversible damage and to maintain their integrity and authenticity, making use of a strategy based on deep knowledge, advanced monitoring, low impact mitigation approach, integrated with the enhancement of local capacity and expertise. • Rock-cut sites were among the first man-made works in the history of humanity, largely present in the Mediterranean regions. • Sites were mainly sacred landscapes, located in selected topographic areas (i.e. vertical cliff), constituted by weak rocks. • Considering geology and topography, rupestrian sites are mainly affected by slope instability, weathering and surface erosion. • Deep knowledge, new technologies and monitoring, are essential in the investigation phase, to understand potential threats. • A low impact and sustainable mitigation strategy is mandatory, to maintain the integrity and authenticity of sites. [ABSTRACT FROM AUTHOR]