Melasma is a common, acquired, symmetrical hypermelanosis that presents as light to dark brown macules on the face, usually over the forehead and malar areas (Fig. 8.1). Women with Fitzpatrick skin types III–V living in areas of increased ultraviolet (UV) light are frequently affected. Melasma is difficult to treat and negatively impacts the quality of life. The most implicated etiological factors include genetic predisposition, exposure to UV radiation (UVR), and hormonal influences.