There has been a widespread world-wide use of flathead mullet, Mugil cephalus, in fish biomonitor studies within the coastal zone. This review summarises this research field, focusing on heavy metals, and considers the implications of the accumulated data. Differences in sampling methodology, tissues analysed and units of reported data provide challenges in assessing and benchmarking these biomonitor studies. The benthic feeding strategy of M. cephalus invariably increases exposure risk relative to middle or upper water column feeders, nevertheless contaminant accumulation via direct and indirect pathways was regulated sufficiently such that toxicants were below food guidelines in most coastal regions (32 of the 49 examined). Human health issues can arise if fish are consumed from heavily industrialised regions. Recommendations are provided for future biomonitoring studies, based on the results for M. cephalus but relevant for fish species more broadly, to provide more comparable data so that managers can benchmark against local conditions.