OBJECTIVES: To assess the management and associated lifetime costs in MM patients as from the diagnosis of unresectable metastatic disease until death. METHODS: A retrospective patient chart review was performed at the Antwerp University Hospital to obtain data on medical consumption related to the management of unresectable MM (uMM). A complete registry of all melanoma patients who visited the hospital between 2007 and May 2013 was compiled. Eligible for this retrospective chart review were patients with uMM with sufficient data available and who deceased before May 2013. Data on demographics, disease characteristics and management of uMM were collected. Direct costs were calculated by multiplying each item of resource use with its unit cost (2013, €) using the Belgian public health care payer’s perspective (PHCP) and patient’s perspective. Average (bootstrap 95%CI) overall costs per patient were calculated.  RESULTS: Out of 338 registered melanoma patients, 35 were eligible and included in this chart review. The median overall survival time (OS) in all patients was 6.2 months. 88.6% (n=31) of patients were treated by systemic treatment(s) of which 17% (n=6) received up to 4 different treatment lines. Ten patients received “new drugs”: ipilimumab (1 to 4 cycles): 10; vemurafenib: 2. Fifty-six (41%) of the 137 hospitalizations were for treatment administration. The mean overall cost per patient was €43,429 (bootstrap 95% CI: 33,372 - 54,351), of which € 42,367 (95%CI: 32,481 - 52,976) was reimbursed. The PHCP cost was driven by systemic treatments costs (46% of cost). Mean PHCP cost was € 87,468 (95 % CI: 77,372-97,307) for patients treated with “new drugs” versus € 24,327 (95 % CI:  18,617 - 30,634) for patients not treated with “new drugs”. Median OS was 9 and 4.9 months, respectively. CONCLUSIONS: Management of uMM results in considerable costs for the PHCP, mainly driven by systemic treatment costs.