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Nosy Mitsio is the largest island of the archipelago and is about 12 kilometres long and three kilometres wide. Its highest peak is 206 metres. White bones and coconut shells lie scattered around the hills. Nosy Mitsio is known for its huge basalt columns, also called the Organ Pipes.

White bones and coconut shells lie scattered around the hills. The island is popular amongst windsurfer and divers. The island and can only be reached by boat. A boat trip from Nosy Be takes between 4 and 6 hours and can be arranged by most dive and tour operators on Nosy Be.