Advances in cancer treatments have significantly improved their effectiveness, yet access to first-line therapies remains limited. A 2017 survey revealed that over 25 % of metastatic melanoma patients in Europe lacked access to recommended therapies. To address this, the European Association of Dermato-Oncology and the European Melanoma Registry conducted a follow-up study on the registration and reimbursement of first-line treatments.A web-based survey using LimeSurvey was distributed to melanoma experts across 27 European countries from February to April 2022 and updated from February to April 2024. The questionnaire covered the percentage of patients receiving recommended treatments, as well as treatment authorization and reimbursement dates for systemic and adjuvant therapies.There has been significant improvement in the registration and reimbursement of BRAFi/MEKi, anti-PD1, and anti-PD1/anti-CTLA4 therapies, increasing from 48 %, 63 %, and 37 % in 2017 to 96 %, 96 %, and 78 % in 2024, respectively. Despite these gains, restrictions persist. Anti-PD1/anti-CTLA4 combination immunotherapy is still not available without restrictions in 48 % of the surveyed countries. The nivolumab/relatlimab combination is licensed only for PDL-1-negative melanoma and reimbursed in seven countries of Europe. Tebentafusp is reimbursed in 15 countries and talimogene laherpervec in 5. In 2024, adjuvant treatments for stage III melanoma are reimbursed in 22 countries for dabrafenib/trametinib and 24 of 27 for anti-PD1 antibodies. Pembrolizumab and nivolumab are reimbursed in 15 and 8 countries, respectively, for stage IIB/IIC disease.While there have been improvements in the reimbursement of metastatic melanoma treatments in Europe, challenges and discrepancies remain. Further efforts at European and global levels are needed to harmonize and enhance access to cancer medicines.

Clinics of Dermatology Faculty of Medicine of Coimbra University Coimbra Portugal

Department of Dermatology and Medical Oncology Universitair Ziekenhuis Brussel Brussels Belgium

Department of Dermatology Aristotle University of Thessaloniki Thessaloniki Greece

Department of Dermatology Elbe Klinikum Buxtehude Buxtehude Germany

Department of Dermatology Medical University of Vienna Vienna Austria

Department of Dermatology University Hospital Schleswig Holstein Campus Kiel Kiel Germany

Department of Dermatology University Hospital Zurich Zurich Switzerland

Department of General and Oncologic Dermatology Ambroise Paré hospital APHP and EA 4340 Biomarkers in cancerology and haematooncology UVSQ Université Paris Saclay Boulogne Billancourt 92104 France

Department of Medical Oncology University of Brussels Belgium

Department of Oncodermatology National Cancer Center Sofia Bulgaria

Department of Oncology Christie NHS Foundation Trust University of Manchester United Kingdom

Department of Oncology Faculty of Medicine University of Constanta Romania

Department of Oncology General University Hospital Prague Prague Czech Republic

Department of Oncology Hospital General Universitario Gregorio Marañón Madrid Spain

Department of Oncology Odense University Hospital Odense Denmark

Department of Oncology University Clinical Center of Sarajevo Sarajevo Bosnia and Herzegovina

Department of Oncology University Hospital Centre Zagreb Zagreb Croatia

Department of Oncotherapy University of Szeged Szeged Hungary

Faculty of Medicine Centre of Dermatovenereology Clinic of Infectious Diseases and Dermatovenereology Vilnius University Vilnius Lithuania

Faculty of Medicine Military Medical Academy Belgrade Serbia

FSBI N N Blokhin National Medical Research Center of Oncology Moscow Russia

Institute of Oncology Ljubljana Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Maria Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Melanoma Cancer Immunotherapy and Development Therapeutics Unit Istituto Nazionale Tumori IRCCS Fondazione G Pascale Napoli Italy

North Estonia Medical Centre Interdisciplinary Cancer Centre Talinn Estonia

Oncodermatology center of the medical chain Dobrobut Kiev Ukraine

Oncology Clinic Clinical Centre of Montenegro Podgorica Montenegro

The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital Amsterdam Netherlands

University Clinic of Radiotherapy and Oncology Faculty of Medicine Ss Cyril and Methodius University Skopje Macedonia

University Hospital Tübingen Tübingen Germany

University Skin Cancer Center Kiel University Hospital of Schleswig Holstein Kiel Germany

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