Background and Study Aim: Hepatocellular carcinoma (HCC) is the fifth most common form of cancer worldwide and the third most common cause of cancer related deaths. This study was designed to investigate the therapeutic efficacy of percutaneous radiofrequency ablation versus microwave (MW) ablation for small HCC measuring ≤ 3 cm in diameter. Patients and methods: This study was carried out in Al-Mahalla Hepatology Teaching Hospital on 30 patients with cirrhosis and small HCC. All the patients were evaluated by thorough history, clinical examination, laboratory investigations, abdominal ultrasound and spiral triphasic CT. Results: The mean age was 56.2±5.8, 70% (21) were males and 30% (9) were females. There was highly statistical significant increase in liver function in MW ablation as regard AST, ALT and bilirubin, and decrease in AFP level of both groups after treatment. There was no significant difference between two groups in the response to treatment as regarding triphasic CT and complications. Conclusion: Microwave (MW) and Radiofrequency (RF) ablation are similar in pathologic appearance and imaging characteristics, but RFA has many limitations and many complications. MW ablation offers many of the advantages of RF ablation while overcoming some of its limitations and the heat-sink effect.