The 2018 Miss Massachusetts USA and Teen USA pageant concluded with Allissa Latham winning the title of Miss Massachusetts USA 2018 and Lexi Woloshchuk winning the title of Miss Massachusetts Teen USA 2018. They also won the opportunity to represent Massachusetts at the 2018 Miss USA and Teen USA pageant.

The Top 5 finalists at the 2018 Miss Massachusetts USA pageant were:

First Runner-Up – Ashley Baptista
Second Runner-Up – Chelsea Demby
Third Runner-Up – Kelly O'Grady
Fourth Runner-Up – Allison DeJesus

The Top 15 placements at the 2018 Miss Massachusetts USA pageant were:

Fatima Armaghan
Gina Butler
Alicia Capone
Gabriella DeCologero
Nicole Eacuello
Taylor Higgins
Meghan McInnis
Rachel Miller
Roxanne Ribot-Gonzalez
Jillian Sabina

The Special Awards at the 2018 Miss Massachusetts USA pageant were:

Miss Congeniality - Elizabeth Roberts
Most Photogenic - Shana Silva

The Top 5 finalists at the 2018 Miss Massachusetts Teen USA pageant were:

First Runner-Up – Elizabeth Rives
Second Runner-Up – Kaymesha Vital
Third Runner-Up – Karina Calhoun
Fourth Runner-Up – Isabella Riethmueller

The Top 15 placements at the 2018 Miss Massachusetts Teen USA pageant were:

Shirin Bakre
Megan Eugenio
Kiersten Khoury
Olivia Lindberg
Katisa Mosquea
Taylor Mulready
Livia Petrillo
Hevyn Pray
Francheska Rosado
Juneichka Rosario

The Special Awards at the 2018 Miss Massachusetts Teen USA pageant were:

Miss Congeniality - Chloe Harris
Most Photogenic – Samantha Gullens