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BACKGROUND Total body skin examinations (TBSE) are commonly performed in clinical practice. There is limited research on best practices for performing a TBSE. OBJECTIVE To optimize the TBSE. METHODS We performed an observational cohort study by video recording 5 dermatology faculty and 5 residents conducting their regular TBSE on both a male and female standardized subject. Exam time, physician movements, subject movements, sequence of body parts examined, and body parts missed were analyzed using an analytic hierarchy process (AHP) matrix. Differences were evaluated by a t-test of unequal variance. P-values <0.05 were deemed significant. RESULTS We identified a optimal format for conducting a TBSE that is efficient and accurate LIMITATIONS: This study was conducted with only healthy examiners and standardized subjects, rather than individuals with a variety of physical and mental disabilities. The structure of the study was not hypothesis driven and assumed that engineers observing physicians performing the total body skin examination would identify the most optimal TBSE. CONCLUSION Our results indicate that a standardized process of performing a TBSE minimizes the chance of missing a body area. This could also have implications on teaching a standardized TBSE to medical students, residents, and physicians.