BACKGROUND: Despite the efficacy of innovative treatments for metastatic melanoma, their high costs has led to disparities in cancer care among different European countries. We analysed the availability of these innovative therapies in Europe and estimated the number of patients without access to first-line recommended treatment per current guidelines of professional entities such as the European Society for Medical Oncology (ESMO), the European Organisation for Research and Treatment of Cancer (EORTC), the European Association of Dermato-Oncology (EADO), and European Dermatology Forum (EDF). MATERIALS AND METHODS: Web-based online survey was conducted in 30 European countries with questions about the treatment schedules from 1st May 2015 to 1st May 2016: number of metastatic melanoma patients, registration and reimbursement of innovative medicines (updated data, as of 1st October 2016), percentage of patients treated and availability of clinical studies and compassionate-use programmes. RESULTS: The recommended BRAF inhibitor (BRAFi) + MEK inhibitor (MEKi) combination was both registered and fully reimbursed in 9/30 (30%) countries, and in 13/30 (43%) (all from Eastern Europe) not reimbursed. First-line immunotherapy with anti-PD1 antibodies was registered and fully reimbursed in 14/30 (47%) countries, while in 13/30 (43%) (all from Eastern Europe) not reimbursed. It was estimated that in Europe 19,600 patients with metastatic melanoma are treated, and 5238 (27%) do not have access to recommended first-line therapy. Significant correlation was found between human development index (HDI, UNDP report 2015), (r = 0.662; p < 0.001), health expenditure per capita (r = 0.695; p < 0.001) and the Mackenbach score of health policy performance (r = 0.765; p < 0.001) with the percentage of patients treated with innovative medicines and a number of reimbursed medicines. CONCLUSIONS: Great discrepancy exists in metastatic melanoma treatment across Europe. It is crucial to increase the awareness of national and European policymakers, oncological societies, melanoma patients' associations and pharma industry.

APHP Hospital Saint Louis Paris France

Carol Davila University of Medicine and Pharmacy Elias University Hospital Bucharest Romania

Centre for Dermatooncology Department of Dermatology Eberhard Karls University Tuebingen Germany

Clinic for Oncology and Radiotherapy Podgorica Montenegro

Clinic of Oncodermatology National Cancer Center Sofia Bulgaria

Department of Clinical Oncology Hospital Universitario Virgen Macarena Sevilla Spain

Department of Dermatology and Allergology University of Szeged Hungary

Department of Dermatology and Venerology and Allergy Medical University Innsbruck Austria

Department of Dermatology Medical Faculty Military Medical Academy Belgrade Serbia

Department of Dermatology Medical Faculty University of Coimbra Portugal

Department of Dermatology Medical University of Vienna Vienna Austria

Department of Dermatology University Hospital Schleswig Holstein Campus Kiel Kiel Germany

Department of Dermatology Vilnius University Lithuania

Department of Medical Oncology Universitair Ziekenhuis Brussel Vrije Universiteit Brussel Brussels Belgium

Department of Oncology Odense University Hospital Denmark

Department of Oncology Pathology Karolinska Institutet and Karolinska University Hospital Solna Stockholm Sweden

Department of Oncology University Hospital Sarajevo Bosnia and Herzegovina

Department of Oncology University Hospital Zagreb Croatia

Division of Dermatology and Venerology Medical University of Graz Graz Austria

General Teaching Hospital Prague Czech Republic

Institute of Dermatology Catholic University of the Sacred Heart Rome Italy

Institute of Oncology and Radiology of Serbia Belgrade Serbia

Institute of Oncology Ljubljana Ljubljana Slovenia

Maria Sklodowska Curie Memorial Cancer Center and Institute of Oncology Warszawa Poland

Mount Vernon Cancer Centre Northwood United Kingdom

N N Alexandrov National Cancer Сenter of Belarus Minsk Belarus

National and Kapodistrian University of Athens Greece

National Cancer Institute Kiev Ukraine

Netherland Cancer Institute Amsterdam Netherlands

NN Blokhin Russian Cancer Research Center Moscow Russia

North Estonia Medical Centre Tallinn Estonia

Service de Dermatologie et Cancérologie Cutanée Hopital de la Timone Marseille France

UniversitätsSpital Zürich Skin Cancer Center University Hospital Zürich Switzerland

University Clinic of Radiotherapy and Oncology Skopje Former Yugoslav Republic of Macedonia

University Hospital Center Sestre Milosrdnice Zagreb Croatia

University Hospital Mother Theresa Tirana Albania

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