OBJECTIVES: The aim of this study was to assess treatment choices for patients diagnosed with metastatic melanoma in SUS settings. METHODS: The patient flow pathway was determined by patients receiving systemic therapy for diagnosed melanoma stage IV (ICD-C43) from a government administrative database (SIA/DATASUS). Patients ineligible for upfront therapy could not be captured. Systemic therapy at each line treatment and time to progression data from Jan/2008 to Jun/2010 was collected. Patients were classified as active (analyzed during all period), lost during follow-up (unknown reason) and dead. RESULTS: Data from 1,049 patients was analyzed, 48.1% lost follow up and 8.3% had documented death. By the end of the study, 43.6% were still active. The average follow-up time was 8.6 months. All patients received at least one line of systemic therapy. First line therapy (FLT), 49.7% received dacarbazine and 29.1% interferon. By Jun/2010, 175 (16.7%) patients received second line therapy (SLT), 42.5% lost follow-up, 6.6% died and 34.2% remained in FLT. The most common SLT regimens were dacarbazine (28.0%), interferon (17.7%) and paclitaxel (14.9%) and the average time to switch from FLT to SLT was 5.5 months. During SLT, 28.0% lost follow-up, 7.4% died and 47.4% of patient remained active till jun/2010. Thirty patients (2.9%) received a third line therapy (TLT), with an average time from the beginning of SLT to TLT of 5.2 months.  Paclitaxel (23.3%) and interferon (20.0%) were the most commonly used regimens. CONCLUSIONS: For metastatic melanoma patients in the SUS, the main chemotherapy regimens in FLT and SLT were dacarbazine and interferon. Paclitaxel was the most common TLT agent along with interferon.