Introduction: Melanosis affecting face and neck occur from a myriad of conditions. The similar overlapping clinical, histological and dermoscopic features posses an intricate diagnostic problem for the clinician. Attempts to classify them have been partially successful. Methods: This was a prospective hospital based study conducted in a tertiary hospital over a period of one year involving 120 patients of facial melanosis. Relevant investigations including skin biopsy and patch testing were done wherever required. Results: Study sample ranged from nine to 60 years with maximum number of patients in 21-40 years of age. Females predominated in the study. Most common diagnosis was melasma followed by pigmented contact dermatitis, periorbital melanosis, lichen planus pigmentosus, erythema dyschromicum perstans, poikiloderma of civatte and eythromelanosis follicularis. Conclusion: There was considerable clinical, histological overlap between these clinical entities. UV exposure in melasma and lichen planus pigmentosus, exposure to allergens in pigmented contact dermatitis were the main etiological factors implicated. Key words: facial melanosis, melasma, pigmented contact dermatitis, lichen planus pigmentosus.