The objective of our study was to determine the incidence of hepatocellular carcinoma (HCC) in French Polynesia and to describe its main risk factors. Patients and Methods—We conducted a descriptive, retrospective study from January 1, 2008, to December 31, 2017, of all cases of HCC diagnosed in French Polynesia. Patients were included in the study based on hospital medical activity data (Medical Information Systems Program: PMSI), data from the pathology department, and records of multidisciplinary team meetings. Each suspected HCC diagnosis was verified according to strict criteria. Results - Ultimately, 139 patients with HCC were included. The mean age at diagnosis was 61.3 years (standard deviation: ±11.3 years) with a sex ratio of 4.6. The age-standardized incidence rate of HCC in French Polynesia in 2017 was 8.2 per 100,000 inhabitants (men: 13.5 and women: 2.7). The most frequently observed known risk factors were obesity (60%), alcohol (56%), and hepatitis B virus (HBV) (51%). The rates of alcohol use and hepatitis C were lower than those reported in mainland France, whereas the rates of obesity and HBV were significantly higher. The HCC incidence rate for the Austral Islands was extremely high, at 43.1, almost always associated with HBV. Conclusion - HCC in French Polynesia is characterized by a high incidence—among the highest in the world for the Austral Islands—and risk factors that differ significantly from those in mainland France, with an extremely high prevalence of HBV and obesity.