Velscope VX Examination Manual
VELscope Vx Step-By-Step
Examination Guide
Note: This is an abbreviated clinical guide. Please see the
VELscope Vx Training DVD for more detailed information.
Review the patient’s relevant medical and 1
dental history.
Conduct a thorough extra-oral and intra-oral 2
examination both visually and manually, palpating
all the structures of the head and neck.
Repeat the intra-oral examination using the 3
VELscope Vx by viewing the oral cavity through
the VELscope Handpiece (Figure 1). Maintain a
distance of approximately 2 inches (5 cm) from
the oral cavity to optimize the visualization of the
natural tissue fluorescence.
Abnormal tissue typically appears as an irregular, 4
dark area that stands out against the otherwise
normal, green fluorescence pattern of surrounding
healthy tissue.
If a suspicious area is discovered, reevaluate under 5
white light and VELscope trying to identify what
might have caused the region to appear abnormal.
Take into consideration its appearance under
both VELscope and white light, its response to
palpation, and salient patient history information.
Photo-document any areas of concern both under 6
white light and through the VELscope Vx.
Record all relevant findings. Documentation forms 7
are available at www.velscope.com.
Inform the patient of all relevant findings and the 8
appropriate course of action.
Follow up or refer as appropriate.9
VELscope Vx Step-By-Step
Examination Guide
Fluorescence Visualization in
the “Normal” Mouth
•
Understand what a normal oral cavity looks like
under VELscope to best appreciate what may be
abnormal.
•
The attached gingiva and anterior tonsillar
pillars, for example, often have a naturally
darker appearance.
•
Pigmented tissue appearing dark under white
light usually also looks dark under VELscope Vx.
•
Inflammation typically appears darker under
VELscope due to the excess blood content.
•
The oral cavity is naturally exposed to varying
degrees of chronic irritation and mild inflammation.
•
Due to inflammation, the buccal mucosa,
lateral surfaces of the tongue and hard palate
may sometimes show darker areas typically
characterized by poorly-defined borders.
•
Hyperkeratosis may often appear bright under
VELscope because of strong keratin fluorescence.
Blanching
•
Observe the suspicious, typically darker, area
through the VELscope Handpiece while applying a
light amount of pressure with the back side of an
explorer or similar instrument in a sweeping motion
to diffuse any blood from the area.
•
If the normal green fluorescence returns with this
pressure, then the lesion may have an inflammatory
component.
•
For some important considerations when
interpreting the effects of blanching, see the
VELscope Vx Training DVD.
Follow-up
•
If a suspicious area cannot be ruled out as benign,
it is usually appropriate to perform a follow-up
examination (typically in 2 weeks).
•
At this time, evaluate whether the suspicious area
has changed, especially if the presumed causative
agent has been removed.
•
If the suspicious area has not cleared up after
this follow-up time, use your clinical judgement
and proceed with further investigation according
to the regular standard of care (e.g. referral to a
specialist, etc.)
Figure 1. VELscope Vx examination: The clinician shines the
blue excitation light into the patient’s oral cavity and looks
through the VELscope Handpiece
Characteristics that Increase Suspicion
of Dysplasia and/or Oral Cancer
•
Highly darkened appearance—strong loss of
fluorescence
•
High-risk location (e.g., lateral/ventral tongue)
•
Unilateral presentation
•
Asymmetry and/or irregular shape
•
Extension over more than one kind of oral structure
Surgical Biopsy – The Gold Standard
•
Remember: the gold standard for diagnosing
precancerous and cancerous lesions in the soft
tissues of the oral cavity is surgical biopsy.
•
A biopsy showing dysplasia is NOT a “false
positive”; discovering lesions early in the disease
development process allows for the highest
probability of a favourable treatment outcome.
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