OBJECTIVES: To determine treatment patterns among individuals treated for unresectable stage III and IV melanoma in the Brazilian public and private health care system. METHODS: A retrospective chart review was conducted in patients with unresectable stage III and IV melanoma or relapsed between January 01 2008 and December 31 2009.  Patients had to have at least two months follow up in 12 private and public oncology centers in Brazil. RESULTS: Treatment was received by 161 eligible patients. The majority of patients were men (54.5%), and 30.3% were first diagnosed at stage IV. Across up to three lines of treatment, 76.4% received systemic therapy, 57.8% had surgery, 37.9% received radiotherapy and 9.3% received supportive care. Among first line treatment, 30.4% received systemic treatment only and 42.2% systemic in combination with surgery and/or radiotherapy. Second line treatment was administered to 67 patients; of those, 88.1% had systemic treatment, 9.0% received surgery, and 10.4% received radiotherapy. Only 26 patients received third line treatment. Outside clinical trial, the most commonly-used drug alone or in combination on first-line was Dacarbazine in both public (82.3%) and private (68.0%) systems, followed by Interferon in the public system (25.8%) and Interleukin in the private system (40.0%). The mean duration of systemic treatment was 17.6 (95% confidence interval (CI) 14.1-21.2) weeks. For second line, the most commonly-used drug was Paclitaxel (31.2%) for private system and Interferon and Paclitaxel (both 24.0%) for public system. Mean systemic treatment duration was 11.8 (95% CI 7.2-16.4) weeks. In third line, Fotemustine  and Dacarbazine were the most commonly-used drugs. CONCLUSIONS: In Brazil the most common treatment for unresectable stage III and IV melanoma is systemic treatment combined with surgery and/or radiotherapy. The most comonly used agent in first line is Dacarbazine; most common second line treatments are Paclitaxel and Interferon.