OBJECTIVES: Treatment of metastatic melanoma has evolved rapidly with changes to the approval and access status of new therapies. In 2016, several agents became available on compassionate use programs and later through public reimbursement, including Immuno-Oncology (I/O) agents. With open access to all available treatments, our objective is to compare the upfront treatment at centers in Canada prior to and after the availability of these new treatments. METHODS: This study used ONCO-CAPPS, a proprietary database of patient chart abstractions collected through regular survey of physician panels. The data includes demographic details, disease markers, and details of patients’ cancer treatment by line of treatment. Data from the time periods 2013 to 2016 were used to identify patients with metastatic melanoma and analyze changes in upfront cancer treatment. RESULTS: CONCLUSIONS: With open access to all treatments for metastatic melanoma, there remains a physician preference for upfront targeted treatment in BRAFm patients. In the first line setting, Immuno-Oncology agents have had the effect of replacing chemotherapy for patients without known BRAF mutation.