Melasma continues to be a challenge in treatment and several issues remain to be solved. The significance of melanophages in treating melasma is questionable. It needs to be clearly addressed whether the therapeutic outcome is really dependent on melanophages. It is still unknown whether the changes in dermis of melasma patients are simple epiphenomenon of chronic sun exposure or a primary event stimulating melanocytes. The role of vascularization in the pigmentation processes definitely needs to be studied further. This field of research may provide new therapeutic options such as anti-angiogenic agents in pigmentary disorders. Finally, it may be very difficult to address the intrinsic genetic alteration in melanocytes of melasma patients. Future work is needed to identify the candidate genes that are responsible for the development of melasma.