Malignant pleural mesothelioma (MPM) is a relatively rare thoracic malignancy accounting for about 2000-3000 new cases per year. This cancer has been increasing in incidence and is strongly associated with asbestos exposure. Also, it is characterized by insidious growth and clinical presentation at an advanced stage of disease. In the past, the treatment of this disease was limited to marginally effective chemotherapy and morbid surgery. This review explores the clinical presentation of MPM, its diagnostic approach and the relevant and recent studies that define the role of chemotherapy, radiation, and various surgical options. Currently, even with aggressive surgical interventions and multimodality strategies, cure remains elusive, although life prolongation has been achieved. Additionally, promising new therapies and interventions that are currently being studied are introduced in this review.