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Objective: To review the experience with conscious sedation administered by dermatologic surgeons at an academic medical center., Design: Retrospective medical chart review., Setting: Outpatient dermatologic surgery unit at an academic medical center., Patients: Fifty episodes of conscious sedation in 37 patients undergoing dermatologic surgical procedures., Intervention: Intravenous and inhaled conscious sedation was administered with strict monitoring during procedures., Main Outcome Measures: Efficacy was subjectively recorded by the administering physician and complications were recorded., Results: Administration of conscious sedation by dermatologic surgeons was associated with good to excellent sedation with minimal complications. Extensive preparation and training were necessary, and strict guidelines devised by a conscious sedation task force were followed. Emergency preparedness was high, although it was not used., Conclusions: Conscious sedation can be safely and effectively administered by dermatologic surgeons in a hospital-based outpatient surgical unit after extensive training. Emergency preparedness is essential, and conservative guidelines should be followed.