Melasma is a common pigmentary dermatosis that occurs on the face of middle-aged women. Due to its high treatment difficulty and tendency to relapse, it not only affects the patients' appearance aesthetics, but also easily triggers psychological problems such as appearance anxiety, exerting multiple negative impacts on patients' quality of life, social function and mental health. This paper systematically reviews the correlation mechanism between melasma and appearance anxiety in middle-aged women, influencing factors and assessment methods, expounds on the impact of appearance anxiety on middle-aged women with melasma, summarizes the intervention strategies and research progress, and puts forward prospects for future research directions, so as to provide references for formulating targeted clinical prevention and treatment strategies.