Malignant pleural mesothelioma (MMP) is a highly aggressive tumor arising of the pleural mesothelium. Asbestos exposure is the main factor involved in the pathogenesis of MMP and according to the late ban of this agent in 2005 the peak incidence in Europe is expected in the next twenty years. The highly aggressive behaviour of this tumor results in a poor prognosis with a mean overall survival between 7 and 9 months. Despite the progress made in diagnosis and therapy of this entity the optimal treatment remains a subject of debate. In this article we review the current state of treatment and diagnosis.