As presented by Raspollini et al., COX-2 expression in unchanged lichen sclerosus cases and lichen sclerosus cases evolving to VSCC were statistically different, and the analysis of COX-2 expression can help identify the patients with a precursor lesion that has a greater potential to evolve into VSCC [14]. The gene discussed is PTGS2; the disease is lichen sclerosus et atrophicus.