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Objective To better understand postoperative opioid use after dermatologic surgery. Design Prospective observational study. Setting Academic dermatology department. Patients The study included 212 adults (1) who were undergoing a single skin excision (including Mohs micrographic surgery), (2) who consented to participate, and (3) who were able to be reached by telephone on postoperative day 3 or 4. Patients who did not meet these criteria and those referred to another physician for further surgical treatment or repair were excluded. Main Outcome Measures The study examined (1) the incidence of opioid prescription after dermatologic surgery, (2) the percentage of prescribed opioid pain medications used in the postoperative period, and (3) patient and surgical characteristics associated with opioid pain medication prescription and use. Results Opioids were prescribed to 72 of the 212 patients (34%). Twenty-five of the 72 patients (35%) who were prescribed opioids did not use them. Forty-nine of 57 patients (86%) who filled an opioid prescription had leftover pills, and 26 of the 49 patients (53%) planned to keep them. Only maximum pain score was significantly associated with opioid use. Conclusions Opioids were overprescribed after dermatologic surgery. Patients who had leftover opioids did not dispose of them properly, which could lead to potential misuse and abuse.