ABSTRACT: Importance:Molecular alterations in lichen sclerosus-associated vulvar squamous cell carcinoma (LS-VSCC) are largely unknown. Objective:To determine whether the retinoic acid receptor ? (RAR?) tumor-suppressor gene is involved in the onset and/or progression of LS-VSCC. Design, Setting, and Participants:The case-control study, conducted at University-Hospital of Ferrara, Italy, included 20 LS-VSCC (mean [SD] age, 75 [3] years) and 20 cancer-associated vulvar LS (caVLS; mean [SD] age, 62 [11] years) formalin-fixed embedded tissue specimens, 20 cancer-free vulvar LS (cfVLS), and 20 normal skin fresh specimens from diagnostic biopsies and women surgically treated for nonmalignant skin lesions, respectively. RAR? gene expression and promoter methylation were investigated in LS-VSCC and caVLS adjacent to VSCC specimens, and in cfVLS and normal skin specimens, as controls, by RT-Q real-time polymerase chain reaction (PCR) analysis, and sequencing of PCR-amplified bisulfite-treated DNA. c-Jun expression, an RAR? pathway-related gene, was also investigated. Main Outcomes and Measures:RAR? expression, correlation with its promoter methylation and c-Jun expression, and association with onset or progression of LS-VSCC. Results:In LS-VSCC, RAR? messenger RNA was 3.4-, 3.6-, and 4.8-fold lower than in caVLS (P?=?.001), cfVLS (P?=?.005), and normal skin (P?