Introduction: Exophytic hepatocellular carcinoma (HCC) need a multidisciplinary approach management tailored to individual patient for a better outcome. Microwave ablation is one of the commonly used ablative modality to treat HCCs. Objective: The aim of this study was to evaluate the efficacy of percutaneous microwave ablation (MWA) for exophytic HCC. Methods: A prospective study was conducted on 40 cases with exophytic HCC. Microwave ablation was performed percutaneously for all patients with followed up. Results: 80 % of cases showed complete ablation while 20 % of cases have incomplete ablation. Only 18.8 % of cases showed recurrence while no recurrence in 81.2 % of cases. The complications of MWA were reported by 15 % of cases and were minor complications. There was significant decrease in alpha fetoprotein (AFP) after MWA. Conclusion: This study showed that microwave ablation can be safely performed for exophytic HCCs with effective and satisfactory outcomes. Results: 80 % of cases showed complete ablation while 20 % of cases have incomplete ablation. Only 18.8 % of cases showed recurrence while no recurrence in 81.2 % of cases. The complications of MWA were reported by 15 % of cases and were minor complications. There was significant decrease in alpha fetoprotein (AFP) after MWA. Conclusion: This study showed that microwave ablation can be safely performed for exophytic HCCs with effective and satisfactory outcomes.