The Effectiveness of VELscope in Monitoring Cellular Alterations in Oral Premalignancies

Background: Oral cancer represents a significant global health issue, accounting for approximately 3% of all malignancies and causing considerable morbidity and mortality. The cellular alterations can result in the development of premalignant conditions, including leukoplakia, erythroplakia, and oral submucous fibrosis. To obtain autofluorescence data on different histopathologically distinct oral lesions and assessment of direct auto fluorescence examination validity in identifying premalignant and malignant lesions using VELscope. Methods: A prospective, randomized in-vivo clinical study was conducted at Department of Oral & Maxillofacial Surgery, Dow University of Health Sciences, Karachi, in time duration of four months (i.e. 18-3-2025 to 17-6-2025) on 160 patients (ages 25–65) with clinically visible oral lesions. VELscope examination was performed to identify abnormal fluorescence (loss of green autofluorescence), followed by incisional biopsy and histopathological analysis. Sensitivity, specificity, and correlations with demographic and lesion characteristics were assessed. SPSS v.26 was used for data analysis. A p-value < 0.05 was considered statistically significant. Results: Abnormal fluorescence was observed in 63.8% (102/160) of cases, strongly correlating with dysplasia/malignancy (p < 0.0001). Leukoplakia was the most common lesion (49.4%), followed by erythroplakia (30.0%) and oral submucous fibrosis (20.6%). No significant associations were found between fluorescence loss and gender (p = 0.610), age (p = 0.565), or lesion type, confirming VELscope’s consistent performance across subgroups. Conclusion: VELscope effectively enhances early detection of oral premalignancies in high-risk populations, guiding targeted biopsies. While its high sensitivity aids screening, false positives necessitate histopathologic confirmation. Future research should explore longitudinal outcomes and cost-effectiveness in diverse settings to optimize clinical integration.