Oral cancer and potentially malignant disorders (OPMDs) are significant public health concerns, particularly in regions with high tobacco consumption. These conditions contribute substantially to morbidity and mortality worldwide, with an increasing burden observed in developing countries (1). The Indian subcontinent, including coastal Andhra Pradesh, has a high prevalence of tobacco use in both smoking and smokeless forms, predisposing individuals to oral precancerous and cancerous conditions (2). Common OPMDs include leukoplakia, erythroplakia, oral submucous fibrosis (OSMF), and lichen planus, all of which have varying risks of malignant transformation (3).

Tobacco contains numerous carcinogens that induce genetic mutations and cellular alterations, promoting malignant transformation in the oral mucosa (4). The early identification and management of OPMDs are crucial for preventing progression to oral cancer. However, many lesions remain undetected during routine visual and tactile examinations, leading to delayed diagnosis and poor survival rates (5). This highlights the need for adjunctive screening tools to enhance the early detection of these lesions.

The Velscope is a non-invasive device that utilizes tissue autofluorescence to detect mucosal abnormalities. It enhances the visualization of dysplastic or neoplastic changes by identifying fluorescence alterations in affected tissues, which may not be visible under conventional white light examination (6). Studies suggest that Velscope improves the sensitivity of detecting oral lesions and serves as a valuable adjunctive tool in clinical practice (7).

This study aims to evaluate the prevalence of oral cancer and OPMDs among tobacco users in a tertiary care setting and assess the efficacy of Velscope as a screening tool. By identifying high-risk individuals and utilizing autofluorescence technology, early diagnosis and intervention can be improved, potentially reducing the burden of oral cancer in high-risk populations. The findings from this study may contribute to the development of improved screening protocols and public health initiatives targeting tobacco-related oral diseases.

Study Design and Setting

This cross-sectional study was conducted at the outpatient department of the Department of Dental Surgery, King George Hospital, Andhra Medical College, Visakhapatnam. The study was done in a span of four months, from November 2024 to February 2025, and aims to assess the prevalence of oral cancer and potentially malignant disorders (OPMDs) among individuals with a history of tobacco use while evaluating the effectiveness of Velscope as a screening tool.

Study Population and Sample Size

A total of 500 participants, including individuals diagnosed with oral cancer, OPMDs (such as leukoplakia, erythroplakia, oral submucous fibrosis (OSMF), and lichen planus), and normal controls, were enrolled. Participants were selected using a random sampling method from the outpatient department, ensuring a diverse representation of individuals at risk.

Inclusion Criteria

1. Individuals above 18 years of age.
2. Clinically and histopathologically confirmed cases of oral cancer and OPMDs, including leukoplakia, OSMF, erythroplakia, lichen planus, and palatal changes in reverse smokers.
3. Participants with a history of tobacco use (both smoking and smokeless forms).
4. Individuals willing to provide informed written consent.

Exclusion Criteria

1. Individuals with no history of tobacco use.
2. Oral lesions unrelated to OPMDs or oral cancer (e.g., traumatic ulcers, vascular lesions, cysts, and tumors).
3. Individuals unwilling to provide consent.

Data Collection and Clinical Examination

A structured proforma was used to record demographic details, medical and habit history, and clinical findings. A thorough clinical examination of the oral and perioral regions was performed using standard dental instruments under direct incandescent light. Participants presenting with suspicious lesions will undergo histopathological examination through a punch biopsy for confirmation.

Velscope Screening

The Velscope device was used to detect autofluorescence changes in the oral mucosa. Velscope examination is not done under ‘’normal’’ white light, instead it uses a specialized blue light to illuminate the oral tissues. The presence of fluorescence loss (areas appearing darker) was noted. Velscope findings was compared with clinical diagnoses and histopathological results to determine its diagnostic accuracy. (Figure 1 and 2)

Figure 1: VELscope examination on normal oral mucosa

Figure 2: VELscope examination on a case of oral cancer

Data Analysis

Statistical analysis was conducted using SPSS software. Descriptive statistics will summarize demographic data and prevalence rates. Comparative analyses, including Chi-square tests for categorical variables and t-tests or ANOVA for continuous variables, was used to examine associations between tobacco use and OPMDs. The effectiveness of Velscope was assessed by calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Receiver Operating Characteristic (ROC) curve analysis will determine its diagnostic accuracy. Correlation tests and logistic regression models was used to identify independent risk factors for OPMDs and oral cancer.

A total of 500 participants were enrolled in the study, including individuals diagnosed with oral cancer (n=150), potentially malignant disorders (n=250), and normal controls (n=100). The demographic distribution, prevalence of OPMDs, and the effectiveness of Velscope in screening these conditions are presented below.

Demographic Characteristics

The study population comprised 320 males (64%) and 180 females (36%). The mean age of participants was 45.2 ± 12.4 years, with the majority (55%) belonging to the age group of 40–60 years. A significant proportion (68%) had a history of smokeless tobacco use, while 32% were smokers.

Table 1: Demographic Characteristics of Study Participants

(Table 1 illustrates the demographic characteristics of the study population.)

Prevalence of OPMDs and Oral Cancer

Among 500 participants, 250 (50%) were diagnosed with OPMDs, with leukoplakia being the most common (40%). OSMF was observed in 30% of cases, followed by palatal changes due to reverse smoking(20%) and lichen planus (10%).

Table 2: Distribution of Oral Cancer and OPMDs

(Table 2 presents the prevalence and distribution of OPMDs and oral cancer cases.)

Effectiveness of Velscope in Screening OPMDs and Oral Cancer

The Velscope screening results were compared with histopathological findings. The device showed a sensitivity of 85%, specificity of 78%, and an overall diagnostic accuracy of 82%. The positive predictive value (PPV) was 81%, while the negative predictive value (NPV) was 82%.

Table 3: Diagnostic Accuracy of Velscope Screening

(Table 3 demonstrates the diagnostic performance of Velscope screening in detecting oral cancer and OPMDs.)

Correlation of Tobacco Use with OPMDs and Oral Cancer

A significant association was observed between the type, duration, and frequency of tobacco use and the presence of oral lesions. Participants using smokeless tobacco for more than 10 years showed a higher prevalence of OPMDs (p < 0.05).

Table 4: Correlation of Tobacco Use Duration with OPMDs and Oral Cancer

(Table 4 highlights the correlation between the duration of tobacco use and the occurrence of OPMDs and oral cancer.)

• The prevalence of OPMDs was 50%, with leukoplakia being the most common lesion.
• Oral cancer was diagnosed in 150 participants, with squamous cell carcinoma accounting for 87% of cases.
• Velscope demonstrated high sensitivity (85%) and specificity (78%) in detecting oral lesions.
• A significant association was observed between prolonged tobacco use and the increased incidence of OPMDs and oral cancer (p < 0.05).

These findings suggest that Velscope is a valuable tool for early screening of OPMDs and oral cancer, particularly in high-risk populations with a history of tobacco use.

Oral cancer and potentially malignant disorders (OPMDs) remain significant public health concerns, particularly in regions with high tobacco consumption. The current study aimed to evaluate the prevalence of these conditions among individuals with a history of tobacco use and assess the effectiveness of Velscope as a screening tool. The findings indicate a high prevalence of OPMDs, with leukoplakia and oral submucous fibrosis (OSMF) being the most common lesions. Moreover, Velscope demonstrated high sensitivity and specificity in detecting these conditions, suggesting its potential as an adjunctive screening tool in clinical settings.

Prevalence of OPMDs and Oral Cancer

The study found that 50% of the participants were diagnosed with OPMDs, with leukoplakia (40%) and OSMF (30%) being the most prevalent. Similar prevalence rates have been reported in previous studies, particularly in populations with high tobacco consumption (1,2). Oral squamous cell carcinoma (OSCC) was the most common malignancy detected, consistent with existing literature indicating that OSCC accounts for over 90% of oral cancer cases globally (3). The high prevalence of OPMDs in this study underscores the need for early detection and preventive interventions to reduce malignant transformation rates.

Association Between Tobacco Use and Oral Lesions

A significant correlation was observed between tobacco use and the presence of OPMDs and oral cancer. Participants using smokeless tobacco for more than 10 years had a significantly higher prevalence of oral lesions (p < 0.05). Several studies have established tobacco as a primary etiological factor for oral precancerous and cancerous conditions due to the presence of carcinogens such as nitrosamines and polycyclic aromatic hydrocarbons (4,5). Smokeless tobacco users are particularly at risk for OSMF due to the presence of areca nut, which contributes to fibrosis of the oral mucosa (6). Additionally, the synergistic effect of tobacco and alcohol use has been implicated in the increased risk of oral cancer (7).

Effectiveness of Velscope in Detecting Oral Lesions

The Velscope device exhibited a sensitivity of 85% and specificity of 78% in detecting OPMDs and oral cancer. Previous studies have reported comparable results, indicating that autofluorescence-based screening enhances the visualization of mucosal abnormalities that might be missed during conventional white-light examination (8,9). The positive predictive value (PPV) of 81% and negative predictive value (NPV) of 82% suggest that Velscope is a reliable adjunctive diagnostic tool. The use of fluorescence visualization technology has been widely explored, with several studies supporting its role in improving the early detection of dysplastic lesions (10,11).

Despite its advantages, Velscope has some limitations. It does not provide a definitive diagnosis but serves as an adjunct to conventional examination methods. Autofluorescence loss can also occur in benign inflammatory conditions, leading to false-positive results (12). Therefore, histopathological confirmation remains the gold standard for diagnosing OPMDs and oral cancer (13).

Clinical and Public Health Implications

The findings of this study highlight the need for integrating advanced screening tools such as Velscope into routine oral examinations, particularly in high-risk populations. Early detection of OPMDs allows for timely intervention, potentially reducing the progression to malignancy (14). Public health initiatives should focus on awareness programs regarding the risks associated with tobacco use and the importance of regular oral screenings.

Furthermore, implementing screening programs at the community level could enhance early diagnosis and improve patient outcomes. Studies have shown that early-stage oral cancer has a significantly better prognosis and lower treatment costs compared to advanced-stage disease (15,16).

Limitations and Future Directions

While the study provides valuable insights, certain limitations must be acknowledged. The cross-sectional design does not establish a causal relationship between tobacco use and OPMDs. Additionally, Velscope screening was limited to clinical settings, and long-term follow-up was not conducted to assess lesion progression. Future research should include longitudinal studies to evaluate the long-term effectiveness of autofluorescence-based screening. Moreover, combining Velscope with other diagnostic modalities, such as salivary biomarkers and molecular profiling, may further enhance early detection accuracy.

This study underscores the high prevalence of OPMDs and oral cancer among tobacco users and highlights the utility of Velscope as a reliable screening tool. The strong correlation between tobacco use and lesion occurrence emphasizes the need for targeted prevention and screening programs. While Velscope offers a non-invasive and effective method for early lesion detection, histopathological confirmation remains essential for definitive diagnosis. Integrating fluorescence-based screening into routine dental practice could significantly improve early detection rates, ultimately reducing the burden of oral cancer.

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