OBJECTIVES: To characterize resource utilization and associated costs of patients receiving systemic therapy outside of a clinical trial for unresectable stage III and IV metastatic melanoma in Brazilian Healthcare System, and to compare results across the public and private health systems. METHODS: A retrospective study was conducted in 12 sites in Brazil to evaluate resource utilization in unresectable stage III and IV metastatic melanoma patients diagnosed or relapsed between 2008-2009. Frequencies of resources utilization were assessed and multiplied by unit costs, obtained by SIA-SUS (Outpatient Information System) for public healthcare costing and by CBHPM-2005 (Brazilian Hierarchy Classification of Medical Procedures) for private. RESULTS: Of 165 total patients eligible for the study, 119 (57 private sector and 62 public sector) received systemic therapy outside of clinical trials and were therefore eligible for the resource utilization analysis.  Across three lines of therapy, 52.9% also received at least one surgery, and 27.7% also received radiotherapy.  While receiving systemic therapy, 29.4% were hospitalized, 13.4% had an emergency room visit, 28.7% had an outpatient visit, and 10.1% had a transfusion.  A similar proportion received surgery in the private and public health sector (56.1% and 50.0%, respectively), with mean costs USD278 (95%CI USD192-365) and USD437 (95%CI USD322-553), respectively. Hospitalizations were more common in the private sector (45.6%) than the public sector (14.5%). The duration of hospitalization among private patients had a mean duration of 8.7 days per month compared to 3.6 days. Mean costs of hospitalizations were USD1,697 (95%CI USD1,020-2,239) in the private sector and USD1,332 (95%CI USD821-1,842) in the public. CONCLUSIONS: In this real-world study in different regions in Brazil, per-patient medical costs in advanced melanoma patients were higher in the private sector than the public sector due to both higher unit cost per resource used and greater utilization of hospitalization.