Malignant pleural mesothelioma (MPM) is a rare but aggressive tumor of the pleura. The prognosis is poor, with a median survival of less than one year. Single agent or combination chemotherapy, as well as radiotherapy, have not consistently improved survival. Radical extrapleural pneumonectomy (EPP) is usually considered as part of trimodal treatment, in combination with preoperative and postoperative chemotherapy and radiotherapy. With advances in preoperative staging, perioperative management, and the development of multimodal approaches, long-term survival is possible. We present a case report of successful use of EPP for the treatment of an extensive diffuse MPM.