We report a case of a 58-year-old Japanese man with epithelioid-type MPM, with a left chest wall protruding tumor, who underwent extrapleural pneumonectomy and chest wall resection. Postsurgical pathology showed that surgical margins were free of mesothelioma cells. Positron emission tomography taken 5 years after surgery showed no recurrence at any site, suggesting that long-term survival could be dependent on margin-free tumor resection or that specific MPM subgroups have lower malignant potential, leading to improved survival.