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Mediterranean tropical-like cyclones, called medicanes, present a multi-scale nature, and their track and intensity have been recognized as highly sensitive to large-scale atmospheric forcing and diabatic heating as represented by the physical parameterizations in numerical weather prediction. Here, we analyse the structure and investigate the predictability of medicanes with the aid of the European Centre for Medium-Range Weather Forecast (ECMWF) Integrated Forecast System (IFS) ensemble forecasting system with 25 perturbed members at 9 km horizontal resolution (compared with the 16 km operational resolution). The IFS ensemble system includes the representation of initial uncertainties from the ensemble data assimilation (EDA) and a recently developed uncertainty representation of the model physics with perturbed parameters (stochastically perturbed parameterizations, SPP). The focus is on three medicanes, Ianos, Zorbas, and Trixie, among the strongest in recent years. In particular, we have carried out separate ensemble simulations with initial perturbations, full physics SPP, with a reduced set of SPP, where only convection is perturbed to highlight the convective nature of medicanes and an operational ensemble combining the SPP and the initial perturbations. It is found that compared with the operational analysis and satellite rainfall data, the forecasts reproduce the tropical-like features of these cyclones. Furthermore, the SPP simulations compare to the initial-condition perturbation ensemble in terms of tracking, intensity, precipitation, and, more generally, in terms of ensemble skill and spread. Moreover, the study confirms that similar processes are at play in the development of the investigated three medicanes, in that the predictability of these cyclones is linked not only to the prediction of the precursor events (namely the deep cutoff low) but also to the interaction of the upper-level advected potential vorticity (PV) streamer with the tropospheric PV anomaly that is diabatically produced by latent heat.