Imaging systems and methods with scattering to reduce source auto-fluorescence and improve uniformity. In some embodiments, the system may include a plurality of trans-illumination light sources configured to irradiate an examination region with different colors of trans-illumination light, while a same diffuser is present in each optical path from the trans-illumination light sources to the examination region. The system also may comprise an excitation light source configured to irradiate the examination region with excitation light. The system may be configured to irradiate the examination region with each of the trans-illumination light sources and, optionally, with the excitation light source, without moving parts in any of the optical paths from the trans-illumination light sources. The system further may comprise an image detector configured to detect grayscale images of the examination region, and a processor configured to create a color trans-illumination image from grayscale images.