Objective To explore the effect of staged nursing on symptom improvement and quality of life in melasma patients treated by 1064 nm laser. Methods A total of 118 melasma patients who underwent 1064 nm laser treatment in Yixing People’s Hospital from March 2023 to March 2026 were selected as the research subjects. According to the random number table method, they were divided into the conventional group and the staged group, with 59 patients in each group. The conventional group received conventional nursing, and the staged group received staged nursing on the basis of conventional nursing. The symptom improvement, quality of life, psychological distress and nursing satisfaction were compared between the two groups. Results After 3 months of intervention, the MASI score of the staged group was lower than that of the conventional group (P <0.05). After 3 months of intervention, the DLQI score of the staged group was lower than that of the conventional group (P <0.05). After 3 months of intervention, the K10 score of the staged group was lower than that of the conventional group (P <0.05). The nursing satisfaction rate of the staged group (96.61%) was higher than that of the conventional group (84.75%) (P <0.05). Conclusion Staged nursing can effectively improve clinical symptoms of melasma patients treated by 1064 nm laser, relieve psychological distress, optimize quality of life, and enhance nursing satisfaction.