Castle Biosciences Announces Preliminary Unaudited Fourth Quarter and Full–Year 2025 Results

Rhea-AI Summary

Castle Biosciences (Nasdaq: CSTL) reported preliminary, unaudited results for Q4 and full-year 2025. 2025 total revenue is expected to exceed $340 million, above prior guidance of $327–$335 million. Core test reports (DecisionDx-Melanoma and TissueCypher) rose 37% year-over-year for 2025 and 42% in Q4. TissueCypher Barrett’s Esophagus reports doubled to 39,014 in 2025. Castle launched AdvanceAD-Tx on limited access in Nov 2025; >50% of ~150 clinician offices ordered within five weeks. Year-end cash and marketable securities are expected to total approximately $300 million ($116M cash; $184M marketable securities). The company cited an April 24, 2025 Medicare coverage change that affected some test volumes and commercial focus.

Positive

• 2025 revenue expected to exceed $340M
• Core test reports +37% YoY for 2025
• Q4 core test reports +42% YoY
• TissueCypher reports 39,014 in 2025 (up from 20,956)
• Year-end cash and marketable securities ≈ $300M
• AdvanceAD-Tx limited launch: >50% of ~150 offices ordered

Negative

• DecisionDx-SCC Q4 reports declined to 3,971 from 4,299
• Medicare coverage change effective April 24, 2025 reduced some volumes
• IDgenetix reports fell to 3,605 in 2025 before discontinuation

News Market Reaction

+0.81%

3 alerts

+0.81% News Effect

+$10M Valuation Impact

$1.22B Market Cap

0.2x Rel. Volume

On the day this news was published, CSTL gained 0.81%, reflecting a mild positive market reaction. Our momentum scanner triggered 3 alerts that day, indicating moderate trading interest and price volatility. This price movement added approximately $10M to the company's valuation, bringing the market cap to $1.22B at that time.

Data tracked by StockTitan Argus on the day of publication.

Key Figures

2025 total revenue: exceeds $340 million Core test growth: 37% increase TissueCypher 2025 volume: 39,014 tests +5 more

8 metrics

2025 total revenue exceeds $340 million Above prior guidance range of $327–$335 million for 2025

Core test growth 37% increase 2025 total test reports for DecisionDx-Melanoma and TissueCypher vs 2024

TissueCypher 2025 volume 39,014 tests 2025 Barrett’s Esophagus test reports vs 20,956 in 2024

DecisionDx-Melanoma 2025 volume 39,083 tests 2025 test reports vs 36,008 in 2024

Year-end 2025 cash $116 million Cash and cash equivalents at Dec. 31, 2025 (preliminary)

Marketable securities $184 million Estimated marketable investment securities at year-end 2025

Q4 core test growth 42% increase Q4 2025 core test reports vs Q4 2024

IDgenetix 2025 volume 3,605 tests Discontinued test in 2025 vs 17,151 in 2024

Market Reality Check

Price: $40.01 Vol: Volume 332,440 is close t...

normal vol

$40.01 Last Close

Volume Volume 332,440 is close to the 20-day average of 338,204, suggesting no unusual trading activity ahead of this update. normal

Technical Shares at $39.34 are trading above the 200-day MA of $24.14 and sit about 6.7% below the 52-week high.

Peers on Argus

CSTL was down 1.38% pre-news while key peers were mixed: NEO up 2.73%, FLGT slig...

1 Up

CSTL was down 1.38% pre-news while key peers were mixed: NEO up 2.73%, FLGT slightly up 0.32%, and CDNA, MYGN, PSNL down between 0.9% and 5.04%. Only one scanner peer (XGN) showed momentum, indicating stock-specific factors rather than a sector-wide move.

Historical Context

5 past events · Latest: Dec 19 (Neutral)

Pattern 5 events

Date	Event	Sentiment	Move	Catalyst
Dec 19	Equity inducement grants	Neutral	-0.4%	Inducement RSU grants under 2022 plan for 83 new employees.
Dec 17	Clinical study data	Positive	+1.6%	Large UM study showed DecisionDx-UM + PRAME outperformed mutation analysis.
Dec 12	Clinical validation data	Positive	+1.7%	Meta-analysis confirmed TissueCypher better identifies high-risk esophageal patients.
Dec 09	Guideline-style endorsement	Positive	+0.4%	Expert panel recommended DecisionDx-Melanoma as best-practice prognostic tool.
Nov 17	Workplace recognition	Positive	+1.5%	Fifth consecutive Houston Chronicle Top Workplace and culture awards.

Pattern Detected

Recent news skewed toward positive clinical and corporate recognition items, with modest positive price reactions generally under 2%, suggesting steady but not explosive responses to good news.

Recent Company History

Over the last few months, CSTL reported multiple supportive data and corporate updates. On Dec. 17, 2025 and Dec. 12, 2025, publications reinforced the clinical utility of DecisionDx-UM + PRAME and TissueCypher, with small positive price moves. A Dec. 9, 2025 expert panel endorsed DecisionDx-Melanoma, and a Nov. 17, 2025 workplace award highlighted corporate strength. The latest preliminary 2025 revenue beat and strong test volume growth build on this sequence of affirming developments.

Market Pulse Summary

This announcement highlights that 2025 revenue is expected to exceed $340 million, above prior guida...

Analysis

This announcement highlights that 2025 revenue is expected to exceed $340 million, above prior guidance, with core test volumes up 37% and strong growth in TissueCypher to 39,014 reports. Cash and marketable securities total about $300 million, reinforcing balance-sheet flexibility. At the same time, management noted Medicare coverage changes and the discontinuation of IDgenetix after volumes dropped to 3,605 tests. Investors may watch reimbursement trends, uptake of AdvanceAD-Tx, and continued growth in core dermatologic and GI tests.

Key Terms

barrett’s esophagus, atopic dermatitis, medicare coverage, marketable investment securities

4 terms

barrett’s esophagus medical

"TissueCypher Barrett’s Esophagus test reports delivered in the quarter were 11,803"

A condition in which the normal lining of the lower esophagus is replaced by tissue more like the intestine, often from long-term acid reflux. It matters to investors because it increases the chance of developing esophageal cancer, driving demand for screening tests, medical procedures and drug development; like a warning light on a car, it signals greater need for medical care and possible regulatory activity that can affect healthcare company revenues.

atopic dermatitis medical

"for patients with moderate-to-severe atopic dermatitis, which materially expands"

A chronic inflammatory skin condition, often called eczema, that causes dry, itchy, red patches and recurring flare-ups; think of it as a persistent rash that can come and go over a person’s life. It matters to investors because its chronic nature and large patient population create steady demand for treatments, influence drug development and approval decisions, affect healthcare costs and reimbursement, and can drive revenue and valuation shifts for companies working on therapies and diagnostics.

medicare coverage regulatory

"Affecting fourth quarter test report volume was the change in Medicare coverage"

Medicare coverage is the set of health insurance benefits provided by the U.S. federal Medicare program that pays for hospital care, doctor services, prescription drugs and certain medical supplies for eligible beneficiaries. Investors pay attention because changes in what Medicare will cover, how much it reimburses, or who qualifies can materially affect revenue and pricing for hospitals, drugmakers, medical device manufacturers and insurers—like rewriting the rulebook for a very large, steady customer.

marketable investment securities financial

"held approximately $184 million in marketable investment securities as of year-end 2025"

Marketable investment securities are financial instruments a company holds that can be sold quickly on public markets for a known price, such as quoted stocks, bonds, or short-term debt. They matter to investors because they act like a liquid reserve—similar to money kept in a readily accessible savings account—affecting a company’s ability to meet obligations, the stability of its cash position, and reported profits when values move.

AI-generated analysis. Not financial advice.

2025 total revenue expected to exceed $340 million, above the previously guided range of $327-335 million

2025 total test reports for our core revenue drivers (DecisionDx^®-Melanoma, TissueCypher^®) increased 37% over 2024

Year-end 2025 cash, cash equivalents and marketable investment securities expected to be approximately $300 million

FRIENDSWOOD, Texas, Jan. 11, 2026 (GLOBE NEWSWIRE) -- Castle Biosciences, Inc. (Nasdaq: CSTL), a company improving health through innovative tests that guide patient care, today announced certain unaudited preliminary performance results for the fourth quarter and year ended Dec. 31, 2025.

“We are extremely pleased with our excellent fourth quarter and full year preliminary results, which reflect both the strength of our innovative test portfolio and the dedication of the entire Castle team,” said Derek Maetzold, president and chief executive officer of Castle Biosciences.

“We exited 2025 exhibiting strong execution and leadership across our dermatologic and gastrointestinal franchises and a strong balance sheet, positioning us well, we believe, to capitalize on our growth opportunities in 2026 and beyond. This includes the November 2025, limited access launch of AdvanceAD-Tx™, our new test designed to help guide systemic treatment decisions for patients with moderate-to-severe atopic dermatitis, which materially expands our total addressable market.”

Preliminary, Unaudited Fourth Quarter Ended Dec. 31, 2025, Highlights

Core revenue drivers:

• Fourth quarter 2025 total test reports for our core revenue drivers (DecisionDx-Melanoma, TissueCypher) increased 42% over the fourth quarter of 2024.
  • DecisionDx-Melanoma test reports delivered in the quarter were 10,022, compared to 8,672 in the fourth quarter of 2024.
  • TissueCypher Barrett’s Esophagus test reports delivered in the quarter were 11,803, compared to 6,672 in the fourth quarter of 2024.
    
    

Additional tests:

• AdvanceAD-Tx was launched on a limited access basis in November 2025. Of the approximately 150 clinician offices that were granted access, more than 50% ordered AdvanceAD-Tx during the first five weeks of clinical availability.
• DecisionDx^®-SCC test reports delivered in the quarter were 3,971, compared to 4,299 in the fourth quarter of 2024. Affecting fourth quarter test report volume was the change in Medicare coverage effective April 24, 2025, and re-focus of our commercial efforts.
• MyPath^® Melanoma test reports delivered in the quarter were 1,045, compared to 879 in the fourth quarter of 2024.
• DecisionDx®-UM test reports delivered in the quarter were 395, compared to 424 in the fourth quarter of 2024.
  
  

Preliminary, Unaudited Year Ended Dec. 31, 2025, Highlights

• 2025 total revenue expected to exceed $340 million, above the previously guided range of $327-335 million.
  
  

Core revenue drivers:

• 2025 total test reports for our core revenue drivers (DecisionDx-Melanoma, TissueCypher) increased 37% over 2024:
  • DecisionDx-Melanoma test reports delivered in 2025 were 39,083, compared to 36,008 in 2024.
  • TissueCypher Barrett's Esophagus test reports delivered in 2025 were 39,014, compared to 20,956 in 2024.
    
    

Additional tests:

• DecisionDx-SCC test reports delivered in 2025 were 17,294, compared to 16,348 in 2024. Affecting twelve-month test report volume was the change in Medicare coverage effective April 24, 2025, and re-focus of our commercial efforts.
• MyPath Melanoma test reports delivered in 2025 were 4,288, compared to 3,909 in 2024.
• DecisionDx-UM test reports delivered in 2025 were 1,769, compared to 1,699 in 2024.
  
  

Discontinued tests:

• IDgenetix test reports delivered in 2025 were 3,605, compared to 17,151 in 2024. The Company discontinued its IDgenetix test offering effective May 2025.
  
  

Cash, Cash Equivalents and Marketable Investment Securities

Year-end 2025 cash and cash equivalents are expected to be approximately $116 million. Additionally, the Company estimates that it held approximately $184 million in marketable investment securities as of year-end 2025.

About Castle Biosciences

Castle Biosciences (Nasdaq: CSTL) is a leading diagnostics company improving health through innovative tests that guide patient care. With a primary focus in dermatologic and gastroenterological disease, we develop personalized, clinically actionable solutions that help improve disease management and patient outcomes.

We put people first—empowering patients and clinicians and informing care decisions through rigorous science and advanced molecular tests that support more confident treatment planning. To learn more, visit www.CastleBiosciences.com and connect with us on LinkedIn, Facebook, X and Instagram.

DecisionDx-Melanoma, DecisionDx-CMSeq, i31-SLNB, i31-ROR, DecisionDx-SCC, MyPath Melanoma, AdvanceAD-Tx, TissueCypher, DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq are trademarks of Castle Biosciences, Inc.

Preliminary Results

Castle Biosciences has not completed the preparation of its financial statements for the fourth quarter or year ended Dec. 31, 2025. The preliminary, unaudited information presented in this press release for the quarter and year ended Dec. 31, 2025 is based on management’s initial review of the information presented and its current expectations and is subject to adjustment as a result of, among other things, the completion of the Company’s end-of-period reporting processes and related activities, including the audit by the Company’s independent registered public accounting firm of the Company’s financial statements. As such, any financial information contained in this press release may differ materially from the information reflected in the Company’s financial statements as of and for the year ended Dec. 31, 2025. Additional information and disclosures would be required for a more complete understanding of the Company’s financial position and results of operations as of and for the quarter and year ended Dec. 31, 2025. Accordingly, undue reliance should not be placed on this preliminary information.

Forward-Looking Statements

This press release contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, which are subject to the “safe harbor” created by those sections. These forward-looking statements include, but are not limited to, statements concerning our expectations regarding: (i) Castle exceeding its full-year 2025 revenue guidance of $327-335 million; (ii) the accuracy of our preliminary test report counts both for full-year and fourth quarter of 2025; (iii) trends in revenues and test report volumes; (iv) the accuracy of our expected year-end 2025 cash and cash equivalents and marketable investment securities; (v) the ability of DecisionDx-Melanoma, TissueCypher, Decision Dx-SCC and AdvanceAD-Tx to bring substantial added value to clinicians and their patients; (vi) Castle’s ability to achieve near- and long-term success and the continued growth of our portfolio points based on individual patient risk; (vii) the anticipated success of our launch of AdvanceAD-Tx; and (viii) the expected expansion of Castle’s total addressable market. The words “anticipate,” “believe,” “could,” “expect,” “estimates,” “guidance,” “may,” “plan,” and similar expressions are intended to identify forward-looking statements, although not all forward-looking statements contain these identifying words. We may not actually achieve the plans, intentions, or expectations disclosed in our forward-looking statements and you should not place undue reliance on our forward-looking statements. Actual results or events could differ materially from the plans, intentions and expectations disclosed in the forward-looking statements that we make. These forward-looking statements involve risks and uncertainties that could cause our actual results to differ materially from those in the forward-looking statements, including, without limitation: our assumptions or expectations regarding reimbursement for our products and subsequent coverage decisions; our estimated total addressable markets for our products and product candidates and the related expenses, capital requirements and potential needs for additional financing; the anticipated cost, timing and success of our product candidates; our plans to research, develop and commercialize new tests; our ability to successfully integrate new businesses, assets, products or technologies acquired through acquisitions; the effects of macroeconomic events and conditions, including inflation and monetary supply shifts, labor shortages, liquidity concerns at, and failures of, banks and other financial institutions or other disruptions in the banking system or financing markets, recession risks, supply chain disruptions, tariffs, outbreaks of contagious diseases and geopolitical events (such as the ongoing conflicts in the Middle East and Ukraine-Russia conflict), among others, on our business and our efforts to address any impact on our business; the possibility that subsequent study or trial results and findings may contradict earlier study or trial results and findings or may not support the results discussed in this press release, including with respect to the tests discussed in this press release; our planned installation of additional equipment and supporting technology infrastructures and implementation of certain process efficiencies may not enable us to increase the future scalability of our TissueCypher Test; the possibility that actual application of our tests may not provide the aforementioned benefits to patients; the possibility that our newer gastroenterology franchise may not contribute to the achievement of our long-term financial targets as anticipated; and the risks set forth under the heading “Risk Factors” in our Annual Report on Form 10-K for the year ended December 31, 2024 and our Quarterly Report on Form 10-Q for the quarter ended September 30, 2025, each filed with the SEC, and in our other filings with the SEC. The forward-looking statements are applicable only as of the date on which they are made, and we do not assume any obligation to update any forward-looking statements, except as may be required by law.

Investor Relations Contact:
Camilla Zuckero
czuckero@castlebiosciences.com
281-906-3868

Media Contact:
Allison Marshall
amarshall@castlebiosciences.com

FAQ

What revenue did Castle Biosciences (CSTL) report for full-year 2025?

Castle expects 2025 total revenue to exceed $340 million, above prior guidance of $327–$335 million.

How much did Castle's core test reports increase in 2025 (CSTL)?

Core test reports (DecisionDx-Melanoma and TissueCypher) increased 37% year-over-year in 2025.

What were Castle's Q4 2025 core test report trends (CSTL)?

Q4 2025 core test reports rose 42% versus Q4 2024; DecisionDx-Melanoma and TissueCypher drove the gain.

How much cash and marketable securities did Castle (CSTL) hold at year-end 2025?

Year-end cash and equivalents were about $116 million plus ~$184 million in marketable securities, totaling ≈ $300 million.

What is AdvanceAD-Tx and when did Castle (CSTL) launch it?

AdvanceAD-Tx is a test to guide systemic treatment for moderate-to-severe atopic dermatitis; it launched on limited access in November 2025.

Did any Medicare policy change affect Castle Biosciences (CSTL) volumes in 2025?

Yes; a Medicare coverage change effective April 24, 2025 affected some test report volumes and commercial focus.