Speaking personally, I'd say that Ackerman in NYC, MGH in Boston and UCSF in S.F. would be my top recommendations for Dermpath (world-wide, actually).
They all have their strengths and weaknesses, but, frankly, the vast majority of the top dogs are from these programs. UCSF is clearly the most research-oriented, while Ackerman (now led by Geoff Gottlieb) sees more than anybody else. MGH is between the two. However, they're so distinctive, that you're likely to see that a person who loves one of the programs would never dream of attending one of the other programs. In reality, however, few would disagree that they produce very, very good Dermpaths. NYU is good too. However, while Kamino is a very good Dermpath, I personally simply has such difficulty understanding her accent that it puts a dampener on my keeness for that program. But yes, it is good too.
In terms of competitiveness, they're all probably the most competitive among the highly competitive Dermpath programs out there.