OP, derm (and plastic surgery) are different from the other highly competitive specialties like radiology, orthopedics, and neuro surgery because the range between the average STEP I score of student who did and did not match is narrower. For example, in derm, the mean step score of American allopathic seniors who matched was a 242 in 2009 while the mean score of American allopathic seniors who did not match was 231. By comparison, the numbers are 238 and 220 for radiology, 240 and 223 for ENT, and 238 and 221 for ortho. Point is, in radiology, ent, and ortho, if you are a middle-of-the-road applicant with some strong cards in your application, you might actually match, particularly into a less than desirable spot. However, in derm, there are just too many qualified applicants and too few spots that if you dont dot all of you Is and cross all of your ts, your prospects arent too bright.