It is not impossible but very difficult.One must be highly motivated early on if possible. Getting to know the right people is a key factor as recommendations from well known Derm faculty members are given heavy weight in the application process.Research projects in med schools are important.Of course an above average med school record/board scores are taken for granted- contrary to popular belief however ..not everyone who gets in is AOA!. Of those who do get in (about 1/3 of the applicants)a high percentage match into their home program.Therefore focus on the Dermatology residency at your own med school,as getting in elsewhere will require a stellar record and/or contacts.