The incidence of melanoma in Australia is the highest in the world. Rural Australian regions have higher incidences of melanoma and patients present with later stage disease compared with metropolitan areas, thus resulting in poorer survival rates. The Wimmera/Grampians region has the lowest five-year survival rate from melanoma in the State of Victoria, Australia. A retrospective audit spanning ten years was performed to determine patterns of presentation and assess the management of melanoma presenting to a regional Victorian hospital, in comparison to state-wide experience. In total, 110 melanoma diagnoses were identified from 2001 to 2010 and 89 included in the audit. Melanomas with a median thickness of 1.09mm were observed (tis=32, t1=34, t2=13, t3=5, t4=4, unknown=4). A large proportion of lentigo maligna (37%) were observed, with prevalence comparable to that of the superficial spreading subtype (38%) (nodular 10%, desmoplastic 2%, spindle cell 1%, not specified 11%). Nine of 65 melanomas had ulceration, with 24 not reported. Thirty-two lesions had margins >2 mm, whilst 18 were <2 mm,14 had positive margins on biopsy, and data not available for 25. Of those with biopsy margins >2 mm, 13 (41%) went on to have a Wide Local Excision (WLE), as did 18 (100%) patients with biopsy margins <2mm, and 12 (86%) with positive margins. Anatomically, the most common site for females was head and neck (30%) and lower limb (30%), and for males head and neck (57%). The poor prognosis of head and neck tumours in an older population presenting with more advanced disease may account for the increased mortality seen in this population previously.