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We developed a single-chip dual-gain scientific CMOS (sCMOS) sensor with red, green, blue (RGB), and NIR channels that provides intrinsically coregistered color reflectance and NIR fluorescence under typical operating room illumination (50\u201380\u2009kLux). A backside illuminated array with division of focal plane (DoFP) pixelated interference filters achieves an input-referred read noise of 2.25 electrons and a fused dynamic range &gt;90\u2009dB, enabling indocyanine green (ICG) detection at ~100\u2009pM under dark-background conditions and ~500\u2009pM under standard 50\u201380\u2009kLux operating-room illumination, with quantification over four orders of magnitude. We integrated the sensor into a surgical camera and evaluated it in 20 patients with lung cancer receiving the cathepsin-activated ICG probe VGT-309 and 35 patients with breast cancer undergoing ICG-guided sentinel lymph node biopsy. In lung cancer, lesion level sensitivity was 0.90 (18\/20) and positive predictive value was 0.78 (18\/23), with at least one clinically significant event in 45% (9\/20) of patients. In breast cancer (90 specimens), high-gain NIR imaging improved classification of gamma probe-designated sentinel lymph nodes by node-to-background ratio (ROC AUC 0.94 vs 0.60) while preserving a white light view. 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