Malignant mesothelioma and tuberculosis are global diseases associated with high mortality. Newly described tumor and immunological markers are important tools in the diagnosis of mesothelioma and pleural tuberculosis. Recent chemotherapeutic strategies and identification of potential targets for local treatment of mesothelioma have provided new hope. Talc improves survival in patients with malignant mesothelioma and is extremely safe when the appropriate size and quantity is used. In this article, we have reviewed the recent advances in diagnosis and treatment of malignant mesothelioma, immunological markers in pleural tuberculosis and safety of talc pleurodesis. © 2008 Elsevier Ltd. All rights reserved.