A pressure ulcer detection system includes a support surface assembly including a transparent window, a signal generator/receiver, and an optical fiber embedded at least in part in the support surface assembly. The fiber conveys outgoing radiation from the signal generator/receiver to the window thereby illuminating a tissue site which overlies the window and conveys incoming radiation reflected from the tissue site and through the window back to the generator/receiver. The system also includes a controller in communication with the signal generator/receiver. The controller comprises a processor adapted to assess health status of tissue at the tissue site based on a property of at least one of the outgoing radiation and the incoming radiation, and to communicate an outcome of the assessment to a destination.