Skin & Regeneration
What Is Melasma? Recognizing the Limits of Appearance
Melasma is an acquired pigmentary condition that often appears as blotchy brown patches on both sides of the face, especially on sun-exposed skin. The Korean Dermatological Association and DermNet describe common facial patterns, but location and color alone cannot confirm it. Freckles and post-inflammatory hyperpigmentation may look similar. Seek clinical assessment for a new, changing, itching, or bleeding spot. This warning concerns pigmented spots generally; it does not mean melasma itself turns malignant.
- Melasma commonly affects both sides of the face, including central facial areas, but distribution alone cannot identify it.
- The color can range from light to dark brown, and borders can be irregular; these are descriptions, not a self-diagnosis checklist.
- Freckles and post-inflammatory hyperpigmentation (PIH), darkening that follows skin inflammation, are among conditions to consider.
- A new or different-looking spot, or one that changes, itches, or bleeds, is a general reason to seek assessment of a pigmented spot. It is not evidence of malignant change in melasma.
The Korean Dermatological Association describes brown patches of varying size, especially on sun-exposed facial skin. DermNet describes acquired, bilateral, blotchy brownish pigmentation. These descriptions explain the term melasma; they do not diagnose a particular patch on the cheeks or forehead.
Where the patches can appear
The Korean Dermatological Association describes the centrofacial pattern as the most common: it can involve the cheeks, forehead, upper lip, nose, and chin. This distribution does not mean every person has patches in the same places or with the same shape.
Usually bilateral, with a range of brown shades
DermNet says melasma usually occurs on both sides of the face and often causes no symptoms. Spots or broader patches may be light to dark brown, sometimes with irregular borders. Appearance alone cannot confirm a diagnosis.
Other pigmentary conditions need consideration
The Korean Dermatological Association says other conditions that leave facial hyperpigmentation need to be considered. DermNet also lists conditions that can resemble melasma. Similar color does not establish the same cause.
Clues from freckles and earlier inflammation
DermNet calls a freckle an ephelis: a small light brown or tan mark. It describes post-inflammatory hyperpigmentation (PIH) as darker color left where an earlier skin condition has healed. Appearance and history can guide assessment, but neither clue establishes a diagnosis alone.
When a new or changing spot needs attention
The American Academy of Dermatology advises assessment of a new spot, one that differs from other spots, or one that changes in size, shape, or color, itches, or bleeds. The advice applies to pigmented spots generally; it does not say melasma itself becomes malignant.
References
- Korean Dermatological Association, “기미 (Melasma)” (in Korean). https://www.derma.or.kr/new/general/disease.php?mod=document&uid=1022
- DermNet, “Melasma (facial pigmentation).” https://dermnetnz.org/topics/melasma
- DermNet, “Ephelis.” https://dermnetnz.org/topics/ephelis
- DermNet, “Postinflammatory hyperpigmentation.” https://dermnetnz.org/topics/postinflammatory-hyperpigmentation
- American Academy of Dermatology, “What to look for: ABCDEs of melanoma.” https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes
Frequently asked questions
Where on the face does melasma commonly appear?
The Korean Dermatological Association describes a common centrofacial pattern across the cheeks, forehead, upper lip, nose, and chin. Its location and shape are not identical in everyone, and distribution alone cannot confirm the diagnosis.
How do melasma and freckles differ?
DermNet describes melasma as usually bilateral, with blotchy light-to-dark brown patches that can have irregular borders. It describes a freckle, or ephelis, as a small light brown or tan mark. Appearance alone cannot reliably distinguish them in an individual.
Is a brown spot where dermatitis healed necessarily melasma?
No. DermNet describes post-inflammatory hyperpigmentation as darkening at the site of an earlier skin condition after it has healed. A similar color does not establish melasma; the history and location of the earlier inflammation matter.
When should a spot that resembles melasma be examined?
The American Academy of Dermatology advises assessment of a new or different-looking pigmented spot, or one changing in size, shape, or color, itching, or bleeding. These are general warning signs for pigmented spots, not a claim that melasma itself becomes malignant.