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Case Report Program
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ViziLite Plus Patient Site

Online Case Report Submission for Doctors

*Practice Name:
*Doctor's Name:
*Doctor's e-mail:
Hygienist's Name:
 
*Patient Risk Profile Data:
Patient Age:
Patient Gender:
Race:
Tobacco user (type and frequency):
Alcohol user (amount and frequency):
 
*Description of the case:
 
*Location of the suspicious tissue identified?
 
*What role did ViziLite play in identifying the tissue?
 
*Was this patient referred to a specialist for further evaluation/treatment?
Yes No
 
What was your differential diagnosis? If biopsied, definitive diagnosis?
 
Please attach digital photo files of the lesion(s) without Vizilite below:
 
Please attach digital photo files of the lesion(s) with Vizilite below:
 
Please attach digital photo files of the lesion(s) marked with TBlue below:
 
* Required information
 
Before submitting a Case Report, please download, print, and have the patient sign the Patient Release Form (to access this form, click here). The signed form should then be placed in the patient's dental records.

By checking here I certify that the patient has signed the Patient Release Form and that the signed form has been placed in the patient's dental records (must be checked to submit a Case Report).

 


Please read the following case submission criteria and program rules prior to submitting a case report.

Case Submission Criteria - Lesion criteria for Case Report Program

Photo Submission Criteria:

*Three (3) digital images (minimum res. 1280 X 1084 pixels) or three (3) high quality photo prints must be submitted and must capture all of the following:

    • The suspicious area under incandescent light. 
    • The same suspicious area/lesion under ViziLite.
    • The same suspicious area/lesion stained with TBlue.
    • Each submitted image or print must have a common anatomical landmark (i.e., teeth).

Acceptable lesion categorization:

  1. Exophytic lump or mass, not well-defined
  2. Homogeneous leukoplakia, erythroplakia or erythroleukoplakia
  3. Ulceration with irregular, raised or indistinct margins
  4. Granular or verrucous mucosal change
  5. Clinical impression of a positive Visual Examination (VE) and/or ViziLite Examination (V+); i.e., defined as positive VE based on the criteria of #'s 1-4 for suspicious lesions above, and/or V+.
Not acceptable lesion categorization:
  1. Flat ulceration with smooth and distinct margins present > 2 weeks
  2. Well-defined exophytic submucosal mass with normal-appearing surface
  3. Discoloration due to dental materials (e.g., amalgam tattoo)
  4. Ethnic pigmentation from melanin deposition
  5. Common benign conditions (e.g., linea alba)

ViziLite Plus Case Report Program Rules 

  1. This program is intended only for purchasers of ViziLite and the ViziLite Plus oral lesion identification and marking system.
  2. By submitting a case under the ViziLite Plus Case Report Program, the submitting practice agrees to be bound by the rules of the program.
  3. The decision to accept or reject any submitted case is the sole decision of Zila Pharmaceuticals, Inc.
  4. Zila Pharmaceuticals, Inc. may post accepted case report summaries on its professional and patient web sites.
  5. Upon acceptance of a submitted case report, Zila Pharmaceuticals, Inc. will remit a payment of $500.00 to the submitting dentist per standard Zila Pharmaceuticals, Inc. accounts payable processes to the address of record at the time of payment.
  6. Zila Pharmaceuticals, Inc., as the sponsor of this program, reserves the right to modify or discontinue the program at any time.
 
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