Board scores don't necessarily mean everything you know. There are a great deal of talented and awsome applicants that don't necessarily have a 250 board score, AOA, with a ton of publications. Just like there are a great deal of applicants to med school who don't necessarily have the numbers but would still make great doctors. #'s are used to weed people out. There really is no reason someone would need a 240 or whatever on step 1 to match into derm, other than to weed applicants out.