Castle Biosciences (CSTL) swings to 2025 loss as margins compress
Filing Impact
Filing Sentiment
Form Type
8-K
Rhea-AI Filing Summary
Castle Biosciences reported modest revenue growth for 2025 but a return to losses as reimbursement and amortization headwinds weighed on results. Full-year revenue was $344.2 million, up 4% from 2024, while total test reports for core dermatologic and GI drivers DecisionDx-Melanoma and TissueCypher grew 37%. TissueCypher volumes nearly doubled, rising to 39,014 tests from 20,956.
Despite strong volume, Medicare coverage changes for DecisionDx-SCC and discontinuation of IDgenetix limited top-line growth. Gross margin was 69% and Adjusted Gross Margin 80%, down from 79% and 82% in 2024, affected by lower DecisionDx-SCC revenue and a one-time $20.1 million amortization acceleration. Full-year net cash from operations was resilient at $64.3 million.
The company swung to a 2025 net loss of $24.2 million, versus net income of $18.2 million in 2024, with net loss per share of $0.83 and Adjusted Net Loss per Share of $0.14. Adjusted EBITDA declined to $44.0 million from $75.0 million. As of December 31, 2025, cash, cash equivalents and marketable securities totaled $299.5 million. Fourth-quarter revenue was $87.0 million, essentially flat year over year, with a quarterly net loss of $2.3 million. For 2026, Castle guides to total revenue of $340–350 million, implying roughly stable sales as it focuses on expanding adoption of its test portfolio, including the new AdvanceAD-Tx atopic dermatitis test.
Positive
- None.
Negative
- None.
Insights
Solid volume growth and cash, but profitability and margins weakened in 2025.
Castle Biosciences delivered strong test adoption but modest revenue growth, highlighting payer and mix pressures. 2025 revenue rose to
Profitability deteriorated. Adjusted EBITDA fell to
Balance sheet strength is a clear offset, with
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 8-K
CURRENT REPORT
Pursuant to Section 13 or 15(d)
of the Securities Exchange Act of 1934
Date of Report (Date of earliest event reported): February 26, 2026
(Exact name of registrant as specified in its charter)
| (state or other jurisdiction of incorporation) | (Commission File Number) | (I.R.S. Employer Identification No.) | ||||||||||||
| (Address of principal executive offices) | (Zip Code) | |||||||||||||
Registrant’s telephone number, including area code: (866 ) 788-9007
(Former name or former address, if changed since last report.)
Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:
Securities registered pursuant to Section 12(b) of the Act:
| Title of each class | Trading Symbol(s) | Name of each exchange on which registered | ||||||||||||
Indicate by check mark whether the registrant is an emerging growth company as defined in Rule 405 of the Securities Act of 1933 (§ 230.405 of this chapter) or Rule 12b–2 of the Securities Exchange Act of 1934 (§ 240.12b–2 of this chapter).
Emerging growth company ☐
If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐
Item 2.02 Results of Operations and Financial Condition.
On February 26, 2026, Castle Biosciences, Inc. (the “Company”) issued a press release announcing its financial results for the fourth quarter and year ended December 31, 2025. A copy of the press release is attached hereto as Exhibit 99.1 and incorporated herein by reference.
The information contained or incorporated in this Current Report on Form 8-K, including Exhibit 99.1, shall not be deemed “filed” for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), or otherwise subject to the liabilities of that section, nor shall it be deemed to be incorporated by reference into any filing under the Exchange Act or the Securities Act of 1933, as amended (the “Securities Act”), except as expressly set forth by specific reference in such filing to this Current Report on Form 8-K.
Item 7.01 Regulation FD Disclosure.
On February 26, 2026, the Company made available the slide presentation attached hereto as Exhibit 99.2. Information from these slide presentations may also be used by the management of the Company in future meetings regarding the Company.
The information contained or incorporated in this Item 7.01 of this Current Report on Form 8-K, including Exhibit 99.2, shall not be deemed “filed” for purposes of Section 18 of the Exchange Act or otherwise subject to the liabilities of that section, nor shall it be deemed to be incorporated by reference into any filing under the Exchange Act or the Securities Act except as expressly set forth by specific reference in such filing to this Current Report on Form 8-K.
Item 9.01 Financial Statements and Exhibits.
(d) Exhibits.
| Exhibit Number | Description | |||||||
| 99.1 | Press release issued February 26, 2026. | |||||||
| 99.2 | Slide presentation. | |||||||
| 104 | Inline XBRL for the cover page of this Current Report on Form 8-K. | |||||||
| SIGNATURES | ||
| Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has caused this report to be signed on its behalf by the undersigned hereunto duly authorized. | ||
| CASTLE BIOSCIENCES, INC. | ||||||||
| By: | /s/ Frank Stokes | |||||||
| Frank Stokes | ||||||||
| Chief Financial Officer | ||||||||
Date: February 26, 2026 | ||||||||
Exhibit 99.1
Castle Biosciences Reports Fourth Quarter and Full–Year 2025 Results
2025 total test reports for our core revenue drivers (DecisionDx®-Melanoma, TissueCypher®) increased 37% over 2024
Exceeded 2025 guidance with full-year revenue of $344 million
Conference call and webcast today at 4:30 p.m. ET
FRIENDSWOOD, Texas – Feb. 26, 2026 – Castle Biosciences, Inc. (Nasdaq: CSTL), a company improving health through innovative tests that guide patient care, today announced its financial results for the fourth quarter and year ended Dec. 31, 2025.
“We closed out an outstanding year with a strong fourth quarter, reflecting the strength of our innovative test portfolio, disciplined execution and the dedication of the entire Castle team who continue to deliver meaningful impact for patients and clinicians every day,” said Derek Maetzold, president and chief executive officer of Castle Biosciences. “We exited 2025 with clear leadership across our core dermatologic and gastrointestinal franchises, highlighted by continued momentum in TissueCypher, which achieved 86% test report growth over 2024.
“We closed out an outstanding year with a strong fourth quarter, reflecting the strength of our innovative test portfolio, disciplined execution and the dedication of the entire Castle team who continue to deliver meaningful impact for patients and clinicians every day,” said Derek Maetzold, president and chief executive officer of Castle Biosciences. “We exited 2025 with clear leadership across our core dermatologic and gastrointestinal franchises, highlighted by continued momentum in TissueCypher, which achieved 86% test report growth over 2024.
“In 2025, we also delivered an important milestone with the limited access launch of AdvanceAD-Tx™, which materially expanded our total addressable market and reinforced our commitment to providing clinical answers to dermatology clinicians and their patients. As we look ahead to 2026 and beyond, we believe we are well positioned to continue delivering stockholder value and capitalize on our near- and long-term opportunities, supported by continued test adoption growth for our core tests, a robust pipeline and a strong balance sheet.”
Twelve Months Ended Dec. 31, 2025, Financial and Operational Highlights
•Revenues were $344.2 million, compared to $332.1 million in 2024, growth of 4% over 2024. Excluding DecisionDx-SCC and IDgenetix revenue, growth of 34% over 2024. Affecting year ended Dec. 31, 2025, revenue was the change in DecisionDx-SCC Medicare coverage effective April 24, 2025, the re-focus of our commercial efforts, as well as the discontinuation of IDgenetix in May 2025.
◦Revenues for our non-dermatologic tests were $127.9 million, compared to $75.1 million in 2024.
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 the 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.
•Gross margin for 2025 was 69%, and Adjusted Gross Margin was 80%, compared to 79% and 82%, respectively, for the same periods in 2024. Affecting 2025 gross margin was the loss of revenues from DecisionDx-SCC and the one-time adjustment of an acceleration of amortization expense of approximately $20.1 million during the three months ended March 31, 2025.
•Net cash provided by operations was $64.3 million, compared to $64.9 million in 2024.
•Net loss for 2025, which includes non-cash stock-based compensation expense of $45.9 million, was $24.2 million, compared to net income of $18.2 million in 2024.
•Net loss per share, Basic and Diluted, was $0.83 and Adjusted Net Loss per Share, Basic and Diluted, was $0.14, compared to net income per share and Adjusted Net Income per Share, Basic and Diluted, of $0.66 and $0.62, respectively, for 2024.
•Adjusted EBITDA for 2025 was $44.0 million, compared to $75.0 million in 2024.
Cash, Cash Equivalents and Marketable Investment Securities
As of Dec. 31, 2025, the Company’s cash, cash equivalents and marketable investment securities totaled $299.5 million.
Fourth Quarter Ended Dec. 31, 2025, Financial and Operational Highlights
•Revenues were $87.0 million, compared to $86.3 million during the same period in 2024, growth of 1% over the fourth quarter of 2024. Excluding DecisionDx-SCC and IDgenetix, revenue growth was 43% over the fourth quarter of 2024. Affecting fourth quarter 2025 revenue was the change in DecisionDx-SCC Medicare coverage effective April 24, 2025, the re-focus of our commercial efforts, as well as the discontinuation of IDgenetix in May 2025.
◦Revenues for our non-dermatologic tests were $38.4 million, compared to $22.5 million during the same period in 2024.
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:
◦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 the 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.
•Gross margin was 76%, and Adjusted Gross Margin was 78%, compared to 76% and 81%, respectively, for the same periods in 2024.
•Net cash provided by operations was $26.9 million, compared to $24.4 million for the same period in 2024.
•Net loss, which includes non-cash stock-based compensation expense of $11.4 million, was $2.3 million, compared to net income of $9.6 million for the same period in 2024.
•Net loss per share and Adjusted Net Loss per Share, Basic and Diluted, was $0.08, compared to net income per share and Adjusted Net Income per Share, Basic and Diluted, of $0.34 and $0.32, respectively, for the same period in 2024.
•Adjusted EBITDA was $11.5 million, compared to $21.3 million for the same period in 2024.
2026 Outlook
The Company anticipates generating between $340-350 million in total revenue in 2026.
Fourth Quarter and Recent Accomplishments and Highlights
Dermatology - Skin Cancer
•The Company announced the publication of an independent expert consensus paper titled “31-Gene Expression Profiling for Cutaneous Melanoma: An Expert Consensus Panel,” which endorsed the Company’s DecisionDx-Melanoma test. Authored by a panel of ten melanoma experts from leading academic and clinical institutions, the paper presented evidence-based recommendations supporting DecisionDx-Melanoma as a best-practice tool for guiding management decisions in patients with cutaneous melanoma (CM). The panel concluded that the test provides prognostic information independent of traditional clinicopathologic factors and can be integrated with existing staging systems to improve patient risk assessment and help optimize clinical decision-making. Drawing on a comprehensive review of 26 published studies encompassing more than 7,500 patients, the panel used a modified Delphi process to reach unanimous agreement on nine consensus statements defining the test’s role in risk stratification, sentinel lymph node biopsy (SLNB) decision making and long-term patient management. See the Company’s news release from Dec. 9, 2025, for more information.
•The Company also announced new data demonstrating the clinical value of its DecisionDx-Melanoma test in improving SLNB decision making and enhancing recurrence risk prediction in patients with CM. The data was featured in two oral presentations at the 2nd European Congress on Dermato-Oncology. By combining the biologic information of a patient’s tumor with traditional staging, DecisionDx-Melanoma is designed to enhance five-year prognostic accuracy in SLN-negative patients and potentially provide additional clarity for identifying those at higher risk of recurrence. These findings support the test’s potential to help clinicians make more risk-aligned therapeutic decisions and tailor follow-up care according to a patient’s individual risk. See the Company’s news release from Nov. 14, 2025, for more information.
Gastroenterology
•The Company announced the publication of a new systematic review and meta-analysis (SRMA) demonstrating that the TissueCypher Barrett’s Esophagus test provides clinically validated risk stratification for patients with Barrett’s esophagus (BE). The findings confirm that TissueCypher can outperform traditional pathology or clinical factors alone to identify patients at increased risk of developing esophageal cancer. The paper, titled “The Tissue Systems Pathology Test Predicts Risk of Progression in Patients With Barrett’s Esophagus: Systematic Review and Meta-Analysis,” was published in the Journal of Clinical Gastroenterology. The analysis consolidated data from six previously published studies and found that TissueCypher consistently identifies patients at greater risk of progression to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC), a key step toward enabling personalized, risk-aligned patient management aimed at preventing cancer. See the Company’s news release from Dec. 12, 2025, for more information.
Dermatology - Atopic Dermatitis
•The Company announced the limited access launch of AdvanceAD-Tx, a 487-gene expression profile test designed to guide systemic treatment decision making in patients
ages 12 and older with moderate-to-severe atopic dermatitis, following a presentation of the prospective, multicenter development and validation study at the 25th Annual Fall Clinical Dermatology Conference (news release), which was recently published in the Journal of the American Academy of Dermatology (JAAD) (news release). AdvanceAD-Tx is designed to identify patients with a Janus kinase inhibitor (JAKi) responder profile who are more likely to achieve an Eczema Area and Severity Index improvement of 90% (EASI-90), more quickly and with reduced flares and itch by three months, when treated with a JAKi compared to a T helper type 2 (Th2)-targeted therapy. See the Company’s news release from Nov. 11, 2025, for more information from Nov. 11, 2025, for more information.
Uveal Melanoma
•The Company announced new data from the largest prospective, multicenter study to date comparing next-generation sequencing (NGS)-based gene mutation analysis with the combination of DecisionDx-UM and Preferentially Expressed Antigen in Melanoma (PRAME) gene expression for predicting outcomes in patients with uveal melanoma (UM). The study, titled “Early Genetic Evolution of Driver Mutations in Uveal Melanoma,” was conducted by the Collaborative Ocular Oncology Group (COOG) and recently published in Nature Communications. See the Company’s news release from Dec. 17, 2025, for more information.
Corporate
•The Company announced that it was recognized by the Houston Chronicle as a Houston Top Workplace, which celebrates people-focused, standout workplace cultures. This marked the fifth consecutive year the Company had been ranked among the Houston metro area’s esteemed workplaces. Castle also earned three Culture Excellence awards in the areas of Employee Appreciation, Employee Well-Being and Professional Development. See the Company’s news release from Nov. 17, 2025, for more information.
Conference Call and Webcast Details
Castle Biosciences will hold a conference call on Thursday, Feb. 26, 2026, at 4:30 p.m. Eastern time to discuss its fourth quarter and full-year 2025 results and provide a corporate update.
A live webcast of the conference call can be accessed here: https://events.q4inc.com/attendee/483643109 or via the webcast link on the Investor Relations page of the Company’s website, https://ir.castlebiosciences.com/overview/default.aspx. Please access the webcast at least 10 minutes before the conference call start time. An archive of the webcast will be available on the Company’s website until March 19, 2026.
To access the live conference call via phone, please dial 833-470-1428 from the United States, or global dial-in numbers are available here: https://www.netroadshow.com/events/global-numbers?confId=94133, at least 10 minutes prior to the start of the call, using the conference ID 695618.
There will be a brief Question & Answer session following management commentary.
Use of Non-GAAP Financial Measures (UNAUDITED)
In this release, we use the metrics of Adjusted Revenues, Adjusted Gross Margin, Adjusted EBITDA and Adjusted Net (Loss) Income per Share, Basic and Diluted, which are non-GAAP financial measures and are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). Adjusted Revenues and Adjusted Gross Margin reflect adjustments to GAAP net revenues to exclude net positive and/or net negative revenue adjustments recorded in the current period associated with changes in estimated variable consideration related to test reports delivered in previous periods. Adjusted Gross Margin further excludes acquisition-related intangible asset amortization. Adjusted EBITDA excludes from net (loss) income: interest income, interest expense, income tax benefit or expense, depreciation and amortization expense, stock-based compensation expense and change in fair value of equity securities. Adjusted Net (Loss)
Income per Share, Basic and Diluted, excludes a one-time adjustment of an acceleration of amortization expense for our IDgenetix test from net (loss) income.
We use Adjusted Revenues, Adjusted Gross Margin, Adjusted EBITDA and Adjusted Net (Loss) Income per Share, Basic and Diluted, internally because we believe these metrics provide useful supplemental information in assessing our revenue and operating performance reported in accordance with GAAP, respectively. We believe that Adjusted Revenues, when used in conjunction with our test report volume information, facilitates investors’ analysis of our current-period revenue performance and average selling price performance by excluding the effects of revenue adjustments related to test reports delivered in prior periods, since these adjustments may not be indicative of the current or future performance of our business. We believe that providing Adjusted Revenues may also help facilitate comparisons to our historical periods. Adjusted Gross Margin is calculated using Adjusted Revenues and therefore excludes the impact of revenue adjustments related to test reports delivered in prior periods, which we believe is useful to investors as described above. We further exclude acquisition-related intangible asset amortization in the calculation of Adjusted Gross Margin. We believe that excluding acquisition-related intangible asset amortization may facilitate gross margin comparisons to historical periods and may be useful in assessing current-period performance without regard to the historical accounting valuations of intangible assets, which are applicable only to tests we acquired rather than internally developed. Adjusted Net (Loss) Income per Share, Basic and Diluted, is calculated by excluding a one-time adjustment of an acceleration of amortization expense for our IDgenetix test from net loss. We believe that providing Adjusted (Loss) Net Income per Share, Basic and Diluted, may also help facilitate comparisons to our historical periods. We believe Adjusted EBITDA may enhance an evaluation of our operating performance because it excludes the impact of prior decisions made about capital investment, financing, investing and certain expenses we believe are not indicative of our ongoing performance. However, these non-GAAP financial measures may be different from non-GAAP financial measures used by other companies, even when the same or similarly titled terms are used to identify such measures, limiting their usefulness for comparative purposes.
These non-GAAP financial measures are not meant to be considered in isolation or used as substitutes for net revenues, gross margin, net (loss) income or net (loss) income per share reported in accordance with GAAP; should be considered in conjunction with our financial information presented in accordance with GAAP; have no standardized meaning prescribed by GAAP; are unaudited; and are not prepared under any comprehensive set of accounting rules or principles. In addition, from time to time in the future, there may be other items that we may exclude for purposes of these non-GAAP financial measures, and we may in the future cease to exclude items that we have historically excluded for purposes of these non-GAAP financial measures. Likewise, we may determine to modify the nature of adjustments to arrive at these non-GAAP financial measures. Because of the non-standardized definitions of non-GAAP financial measures, the non-GAAP financial measure as used by us in this press release and the accompanying reconciliation tables have limits in their usefulness to investors and may be calculated differently from, and therefore may not be directly comparable to, similarly titled measures used by other companies. Accordingly, investors should not place undue reliance on non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are presented in the tables at the end of this release.
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.
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: Castle’s 2026 total revenue guidance of $340-350 million; continued top-line performance and growth of test volumes; the ability of DecisionDx-Melanoma, DecisionDx-SCC, TissueCypher and AdvanceAD-Tx to bring substantial added value to clinicians and their patients; the ability of DecisionDx-Melanoma to (i) reduce mortality risk compared to untested patients, (ii) improve patient survival; and (iii) provide clarity in overall risk beyond histology;; the anticipated success of our planned commercial rollout of AdvanceAD-Tx; the expected expansion of Castle’s total addressable market and Castle’s ability to achieve near- and long-term success and the continued growth of our portfolio. The words “anticipate,” “believe,” “can,” “could,” “expect,” “guidance,” “may,” “plan,” “providing,” 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 Dec. 31, 2025, and our subsequent Quarterly Reports on Form 10-Q, to be 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
###
CASTLE BIOSCIENCES, INC.
CONSOLIDATED STATEMENTS OF OPERATIONS
(in thousands, except per share data)
| Three Months Ended December 31, | Twelve Months Ended December 31, | ||||||||||||||||||||||
| 2025 | 2024 | 2025 | 2024 | ||||||||||||||||||||
| (unaudited) | |||||||||||||||||||||||
| NET REVENUES | $ | 87,010 | $ | 86,311 | $ | 344,229 | $ | 332,069 | |||||||||||||||
| OPERATING EXPENSES | |||||||||||||||||||||||
| Cost of sales (exclusive of amortization of acquired intangible assets) | 18,315 | 16,183 | 71,028 | 60,205 | |||||||||||||||||||
| Research and development | 13,515 | 11,773 | 51,850 | 52,041 | |||||||||||||||||||
| Selling, general and administrative | 56,731 | 49,965 | 229,323 | 200,047 | |||||||||||||||||||
| Amortization of acquired intangible assets | 2,276 | 4,340 | 34,838 | 11,106 | |||||||||||||||||||
| Total operating expenses, net | 90,837 | 82,261 | 387,039 | 323,399 | |||||||||||||||||||
| Operating (loss) income | (3,827) | 4,050 | (42,810) | 8,670 | |||||||||||||||||||
| Interest income | 2,896 | 3,372 | 11,772 | 12,916 | |||||||||||||||||||
| Net (losses) gains on equity securities | (1,855) | 555 | 1,466 | 555 | |||||||||||||||||||
| Interest expense | (24) | (92) | (86) | (577) | |||||||||||||||||||
| Other income | 96 | — | 144 | — | |||||||||||||||||||
| (Loss) income before income taxes | (2,714) | 7,885 | (29,514) | 21,564 | |||||||||||||||||||
| Income tax (benefit) expense | (382) | (1,705) | (5,356) | 3,319 | |||||||||||||||||||
| Net (loss) income | $ | (2,332) | $ | 9,590 | $ | (24,158) | $ | 18,245 | |||||||||||||||
| (Loss) earnings per share: | |||||||||||||||||||||||
| Basic | $ | (0.08) | $ | 0.34 | $ | (0.83) | $ | 0.66 | |||||||||||||||
| Diluted | $ | (0.08) | $ | 0.32 | $ | (0.83) | $ | 0.62 | |||||||||||||||
| Weighted-average shares outstanding: | |||||||||||||||||||||||
| Basic | 29,333 | 28,126 | 28,986 | 27,776 | |||||||||||||||||||
| Diluted | 29,333 | 30,200 | 28,986 | 29,255 | |||||||||||||||||||
Stock-Based Compensation Expense
Stock-based compensation expense is included in the consolidated statements of operations as follows (in thousands):
| Three Months Ended December 31, | Twelve Months Ended December 31, | ||||||||||||||||||||||
| 2025 | 2024 | 2025 | 2024 | ||||||||||||||||||||
| (unaudited) | |||||||||||||||||||||||
| Cost of sales (exclusive of amortization of acquired intangible assets) | $ | 1,342 | $ | 1,350 | $ | 5,666 | $ | 5,529 | |||||||||||||||
| Research and development | 1,748 | 1,987 | 7,555 | 9,598 | |||||||||||||||||||
| Selling, general and administrative | 8,316 | 8,102 | 32,672 | 35,193 | |||||||||||||||||||
| Total stock-based compensation expense | $ | 11,406 | $ | 11,439 | $ | 45,893 | $ | 50,320 | |||||||||||||||
CASTLE BIOSCIENCES, INC.
CONSOLIDATED STATEMENTS OF COMPREHENSIVE (LOSS) INCOME
(in thousands)
| Three Months Ended December 31, | Twelve Months Ended December 31, | ||||||||||||||||||||||
| 2025 | 2024 | 2025 | 2024 | ||||||||||||||||||||
| (unaudited) | |||||||||||||||||||||||
| Net (loss) income | $ | (2,332) | $ | 9,590 | $ | (24,158) | $ | 18,245 | |||||||||||||||
| Other comprehensive income (loss): | |||||||||||||||||||||||
| Net unrealized gain (loss) on marketable investment securities | 27 | (243) | 37 | 94 | |||||||||||||||||||
| Comprehensive (loss) income | $ | (2,305) | $ | 9,347 | $ | (24,121) | $ | 18,339 | |||||||||||||||
CASTLE BIOSCIENCES, INC.
CONSOLIDATED BALANCE SHEETS
(in thousands)
| December 31, | |||||||||||
| 2025 | 2024 | ||||||||||
| ASSETS | |||||||||||
| Current Assets | |||||||||||
| Cash and cash equivalents | $ | 116,729 | $ | 119,709 | |||||||
| Marketable investment securities | 182,776 | 173,421 | |||||||||
| Accounts receivable, net | 43,382 | 51,218 | |||||||||
| Inventory | 10,254 | 8,135 | |||||||||
| Prepaid expenses and other current assets | 7,956 | 7,671 | |||||||||
| Total current assets | 361,097 | 360,154 | |||||||||
| Long-term accounts receivable, net | 1,878 | 918 | |||||||||
| Property and equipment, net | 97,443 | 51,122 | |||||||||
| Operating lease assets | 14,795 | 11,584 | |||||||||
| Goodwill and other intangible assets, net | 99,574 | 106,229 | |||||||||
| Other assets – long-term | 3,769 | 1,228 | |||||||||
| Total assets | $ | 578,556 | $ | 531,235 | |||||||
| LIABILITIES AND STOCKHOLDERS’ EQUITY | |||||||||||
| Current Liabilities | |||||||||||
| Accounts payable | $ | 18,711 | $ | 6,901 | |||||||
| Accrued compensation | 38,287 | 32,555 | |||||||||
| Contingent consideration | 1,000 | — | |||||||||
| Operating lease liabilities | 1,325 | 1,665 | |||||||||
| Current portion of long-term debt | 417 | 278 | |||||||||
| Other accrued and current liabilities | 8,937 | 7,993 | |||||||||
| Total current liabilities | 68,677 | 49,392 | |||||||||
| Long-term debt | 9,640 | 9,745 | |||||||||
| Noncurrent portion of contingent consideration | 1,500 | — | |||||||||
| Noncurrent operating lease liabilities | 25,217 | 14,345 | |||||||||
| Noncurrent finance lease liabilities | 314 | 311 | |||||||||
| Deferred tax liability | 2,335 | 1,607 | |||||||||
| Total liabilities | 107,683 | 75,400 | |||||||||
| Stockholders’ Equity | |||||||||||
| Preferred stock | — | — | |||||||||
| Common stock | 30 | 28 | |||||||||
| Additional paid-in capital | 694,860 | 655,703 | |||||||||
| Accumulated deficit | (224,284) | (200,126) | |||||||||
| Accumulated other comprehensive income | 267 | 230 | |||||||||
| Total stockholders’ equity | 470,873 | 455,835 | |||||||||
| Total liabilities and stockholders’ equity | $ | 578,556 | $ | 531,235 | |||||||
CASTLE BIOSCIENCES, INC.
CONSOLIDATED STATEMENTS OF CASH FLOWS
(in thousands)
| Twelve Months Ended December 31, | |||||||||||
| 2025 | 2024 | ||||||||||
| OPERATING ACTIVITIES | |||||||||||
| Net (loss) income | $ | (24,158) | $ | 18,245 | |||||||
| Adjustments to reconcile net (loss) income to net cash provided by operating activities: | |||||||||||
| Depreciation and amortization | 40,771 | 15,997 | |||||||||
| Stock-based compensation expense | 45,893 | 50,320 | |||||||||
| Net gains on equity securities | (1,466) | (555) | |||||||||
| Deferred income taxes | (6,228) | 1,401 | |||||||||
| Accretion of discounts on marketable investment securities | (4,219) | (6,685) | |||||||||
| Other | 153 | 268 | |||||||||
| Change in operating assets and liabilities: | |||||||||||
| Accounts receivable | 6,876 | (12,643) | |||||||||
| Prepaid expenses and other current assets | (544) | (1,142) | |||||||||
| Inventory | (2,142) | (193) | |||||||||
| Operating lease assets | 1,372 | 1,322 | |||||||||
| Other assets | (366) | 262 | |||||||||
| Accounts payable | 3,078 | (4,372) | |||||||||
| Operating lease liabilities | (1,275) | (1,289) | |||||||||
| Accrued compensation | 5,732 | 3,610 | |||||||||
| Other accrued and current liabilities | 870 | 320 | |||||||||
| Net cash provided by operating activities | 64,347 | 64,866 | |||||||||
| INVESTING ACTIVITIES | |||||||||||
| Purchases of marketable investment securities | (188,714) | (205,729) | |||||||||
| Proceeds from maturities of marketable investment securities | 189,200 | 183,900 | |||||||||
| Proceeds from sale of equity securities | 1,533 | — | |||||||||
| Purchases of debt securities classified as held-to-maturity | (5,569) | — | |||||||||
| Asset acquisition, net of cash and cash equivalents acquired | (18,727) | — | |||||||||
| Issuance of loan receivable | (2,114) | — | |||||||||
| Purchases of property and equipment | (36,021) | (28,326) | |||||||||
| Proceeds from sale of property and equipment | 45 | 18 | |||||||||
| Net cash used in investing activities | (60,367) | (50,137) | |||||||||
| FINANCING ACTIVITIES | |||||||||||
| Proceeds from exercise of common stock options | 2,206 | 2,017 | |||||||||
| Payment of employees’ taxes on vested restricted stock units | (11,657) | (8,762) | |||||||||
| Proceeds from contributions to the employee stock purchase plan | 2,416 | 2,981 | |||||||||
| Repayment of principal portion of finance lease liabilities | (115) | (97) | |||||||||
| Proceeds from lease incentives received | 190 | — | |||||||||
| Proceeds from issuance of term debt | — | 10,000 | |||||||||
| Net cash (used in) provided by financing activities | (6,960) | 6,139 | |||||||||
| NET CHANGE IN CASH AND CASH EQUIVALENTS | (2,980) | 20,868 | |||||||||
| Beginning of year | 119,709 | 98,841 | |||||||||
| End of year | $ | 116,729 | $ | 119,709 | |||||||
CASTLE BIOSCIENCES, INC.
Reconciliation of Non-GAAP Financial Measures (UNAUDITED)
The table below presents the reconciliation of Adjusted Revenues, Adjusted Gross Margin and Adjusted Net (Loss) Income Per Share, Basic and Diluted, which are non-GAAP financial measures. See "Use of Non-GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use of non-GAAP financial measures.
| Three Months Ended December 31, | Twelve Months Ended December 31, | ||||||||||||||||||||||
| (in thousands, except per share data) | 2025 | 2024 | 2025 | 2024 | |||||||||||||||||||
| Adjusted Revenues | |||||||||||||||||||||||
| Net revenues (GAAP) | $ | 87,010 | $ | 86,311 | $ | 344,229 | $ | 332,069 | |||||||||||||||
| Revenue associated with test reports delivered in prior periods | (5,134) | (491) | 7,592 | 1,751 | |||||||||||||||||||
| Adjusted Revenues (Non-GAAP) | $ | 81,876 | $ | 85,820 | $ | 351,821 | $ | 333,820 | |||||||||||||||
| Adjusted Gross Margin | |||||||||||||||||||||||
Gross margin (GAAP)1 | $ | 66,419 | $ | 65,788 | $ | 238,363 | $ | 260,758 | |||||||||||||||
| Amortization of acquired intangible assets | 2,276 | 4,340 | 34,838 | 11,106 | |||||||||||||||||||
| Revenue associated with test reports delivered in prior periods | (5,134) | (491) | 7,592 | 1,751 | |||||||||||||||||||
| Adjusted Gross Margin (Non-GAAP) | $ | 63,561 | $ | 69,637 | $ | 280,793 | $ | 273,615 | |||||||||||||||
Gross Margin percentage (GAAP)2 | 76.3 | % | 76.2 | % | 69.2 | % | 78.5 | % | |||||||||||||||
Adjusted Gross Margin percentage (Non-GAAP)3 | 77.6 | % | 81.1 | % | 79.8 | % | 82.0 | % | |||||||||||||||
| Adjusted Net (Loss) Income per Share, Basic and Diluted | |||||||||||||||||||||||
| Net (loss) income (GAAP) | $ | (2,332) | $ | 9,590 | $ | (24,158) | $ | 18,245 | |||||||||||||||
Amortization of acquired intangible assets4 | — | — | 20,099 | — | |||||||||||||||||||
| Adjusted Net (Loss) Income (Non-GAAP) | $ | (2,332) | $ | 9,590 | $ | (4,059) | $ | 18,245 | |||||||||||||||
| Weighted-average shares outstanding | |||||||||||||||||||||||
| Basic | 29,333 | 28,126 | 28,986 | 27,776 | |||||||||||||||||||
| Diluted | 29,333 | 30,200 | 28,986 | 29,255 | |||||||||||||||||||
Net (loss) income per share (GAAP)5 | |||||||||||||||||||||||
| Basic | $ | (0.08) | $ | 0.34 | $ | (0.83) | $ | 0.66 | |||||||||||||||
| Diluted | $ | (0.08) | $ | 0.32 | $ | (0.83) | $ | 0.62 | |||||||||||||||
Adjusted Net (Loss) Income per Share (Non-GAAP)6 | |||||||||||||||||||||||
| Basic | $ | (0.08) | $ | 0.34 | $ | (0.14) | $ | 0.66 | |||||||||||||||
| Diluted | $ | (0.08) | $ | 0.32 | $ | (0.14) | $ | 0.62 | |||||||||||||||
1.Calculated as net revenues (GAAP) less the sum of cost of sales (exclusive of amortization of acquired intangible assets) and amortization of acquired intangible assets.
2.Calculated as gross margin (GAAP) divided by net revenues (GAAP).
3.Calculated as Adjusted Gross Margin (Non-GAAP) divided by Adjusted Revenues (Non-GAAP).
4.Represents a one-time adjustment of an acceleration of amortization expense for our IDgenetix test during the three months ended March 31,2025.
5.Calculated as net (loss) income (GAAP) divided by weighted-average shares outstanding, basic and diluted.
6.Calculated as Adjusted Net (Loss) Income (Non-GAAP) divided by weighted-average shares outstanding, basic and diluted.
The table below presents the reconciliation of Adjusted EBITDA, which is a non-GAAP financial measure. See "Use of Non-GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use of non-GAAP financial measures.
| Three Months Ended December 31, | Twelve Months Ended December 31, | ||||||||||||||||||||||
| (in thousands) | 2025 | 2024 | 2025 | 2024 | |||||||||||||||||||
| Adjusted EBITDA | |||||||||||||||||||||||
| Net (loss) income | $ | (2,332) | $ | 9,590 | $ | (24,158) | $ | 18,245 | |||||||||||||||
| Interest income | (2,896) | (3,372) | (11,772) | (12,916) | |||||||||||||||||||
| Interest expense | 24 | 92 | 86 | 577 | |||||||||||||||||||
| Income tax (benefit) expense | (382) | (1,705) | (5,356) | 3,319 | |||||||||||||||||||
| Depreciation and amortization expense | 3,777 | 5,768 | 40,771 | 15,997 | |||||||||||||||||||
| Stock-based compensation expense | 11,406 | 11,439 | 45,893 | 50,320 | |||||||||||||||||||
| Net losses (gains) on equity securities | 1,855 | (555) | (1,466) | (555) | |||||||||||||||||||
| Adjusted EBITDA (Non-GAAP) | $ | 11,452 | $ | 21,257 | $ | 43,998 | $ | 74,987 | |||||||||||||||
©2026 Castle Biosciences 1 Empowering people, informing care decisions February 2026
©2026 Castle Biosciences 2 Disclaimers Forward Looking Statements This presentation 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 positioning for continued growth and value creation; our estimated U.S. total addressable market for our commercially available tests; our ongoing studies generating data and their impact on driving adoption of our tests; study observations and interpretations of study data, including conclusions about the benefits and impact of our tests on treatment decisions and patient outcomes; our ability to advance penetration of our tests with clinicians and payers; our ability to carry out our commercial strategies; our future approach to capital allocation; pipeline opportunities to expand screening and diagnostic support for patients; our test volume growth strategy and expectations; our ability to maintain strong adjusted gross margin and a strong balance sheet; and the timing and achievement of program milestones. The words “anticipates,” “can,” “could,” “estimates,” “expects,” “may,” “potential,” “target” 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 estimates and assumptions underlying our estimated U.S. total addressable market for our commercially available tests; our assumptions or expectations regarding continued reimbursement for our products and subsequent coverage decisions; Novitas’ local coverage determination signifying non-coverage by Medicare of our DecisionDx-SCC test; our estimated total addressable markets for our products and product candidates; the 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 or developed through collaborations; the effects of macroeconomic events and conditions, including inflation and monetary supply shifts, tariffs and disruptions to trade, labor shortages, liquidity concerns at, and failures of, banks and other financial institutions or other disruptions in the banking system or financing markets and recession risks, supply chain disruptions, 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 its 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 presentation, including with respect to the diagnostic and prognostic tests discussed in this presentation; 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 anticipated benefits to patients; the possibility that our newer gastroenterology and mental health franchises 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, 2025, and our subsequent Quarterly Reports on Form 10-Q, each filed or to be 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.
©2026 Castle Biosciences 3 Disclaimers Financial Information; Non-GAAP Financial Measures In this presentation, we use the metrics of Adjusted Revenues, Adjusted Gross Margin and Adjusted EBITDA, which are non-GAAP financial measures and are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). Adjusted Revenues and Adjusted Gross Margin reflect adjustments to GAAP net revenues to exclude net positive and/or net negative revenue adjustments recorded in the current period associated with changes in estimated variable consideration related to test reports delivered in previous periods. Adjusted Gross Margin further excludes acquisition-related intangible asset amortization. Adjusted EBITDA excludes from net (loss) income: interest income, interest expense, income tax expense (benefit), depreciation and amortization expense, stock-based compensation expense and change in fair value of trading securities. We use Adjusted Revenues, Adjusted Gross Margin and Adjusted EBITDA internally because we believe these metrics provide useful supplemental information in assessing our revenue and operating performance reported in accordance with GAAP, respectively. We believe that Adjusted Revenues, when used in conjunction with our test report volume information, facilitates investors’ analysis of our current-period revenue performance and average selling price performance by excluding the effects of revenue adjustments related to test reports delivered in prior periods, since these adjustments may not be indicative of the current or future performance of our business. We believe that providing Adjusted Revenues may also help facilitate comparisons to our historical periods. Adjusted Gross Margin is calculated using Adjusted Revenues and therefore excludes the impact of revenue adjustments related to test reports delivered in prior periods, which we believe is useful to investors as described above. We further exclude acquisition-related intangible asset amortization in the calculation of Adjusted Gross Margin. We believe that excluding acquisition-related intangible asset amortization may facilitate gross margin comparisons to historical periods and may be useful in assessing current-period performance without regard to the historical accounting valuations of intangible assets, which are applicable only to tests we acquired rather than internally developed. We believe Adjusted EBITDA may enhance an evaluation of our operating performance because it excludes the impact of prior decisions made about capital investment, financing, investing and certain expenses we believe are not indicative of our ongoing performance. However, these non-GAAP financial measures may be different from non-GAAP financial measures used by other companies, even when the same or similarly titled terms are used to identify such measures, limiting their usefulness for comparative purposes. These non-GAAP financial measures are not meant to be considered in isolation or used as substitutes for net revenues, gross margin, or net (loss) income reported in accordance with GAAP; should be considered in conjunction with our financial information presented in accordance with GAAP; have no standardized meaning prescribed by GAAP; are unaudited; and are not prepared under any comprehensive set of accounting rules or principles. In addition, from time to time in the future, there may be other items that we may exclude for purposes of these non- GAAP financial measures, and we may in the future cease to exclude items that we have historically excluded for purposes of these non-GAAP financial measures. Likewise, we may determine to modify the nature of adjustments to arrive at these non-GAAP financial measures. Because of the non-standardized definitions of non-GAAP financial measures, the non-GAAP financial measure as used by us in this press release and the accompanying reconciliation tables have limits in their usefulness to investors and may be calculated differently from, and therefore may not be directly comparable to, similarly titled measures used by other companies. Accordingly, investors should not place undue reliance on non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are presented in the tables at the end of this presentation. Industry and Market Data This presentation includes certain information and statistics obtained from third-party sources. The Company has not independently verified the accuracy or completeness of any such third- party information.
©2026 Castle Biosciences 4 Registered Trademarks 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.
©2026 Castle Biosciences 5 Improving health through innovative tests that guide patient care OUR MISSION Transforming disease management by keeping people first: patients, clinicians, employees, and investors OUR VISION
©2026 Castle Biosciences 6 Fourth Quarter and Full–Year 2025 Results Highlights 1 Announced launch of AdvanceAD-Tx, the Company’s test designed to guide systemic therapy decision making in patients ages 12 and older with moderate-to-severe atopic dermatitis 5 Net cash provided by operations in 2025 was $64.3 million, compared to $64.9 million in 2024 Achieved provided guidance of high single-digit percentage volume growth at 9% for DecisionDx-Melanoma for full year 2025 over 2024 6 As of December 31, 2025, cash, cash equivalents and marketable investment securities totaled $299.5 million 2 3 4 1 Total test reports for our core revenue drivers (DecisionDx-Melanoma, TissueCypher) increased 42% in Q4 2025 year over year, driving 37% growth for full year 2025 Entered into a collaboration and license agreement with SciBase and completed the acquisition of Previse
©2026 Castle Biosciences 7 Proven strategy designed to drive value creation for our stakeholders FOCUS on best/first-in-class tests with high, unmet clinical need and significant market opportunity BUILD robust clinical evidence PENETRATE target markets to further test adoption by clinicians and payers
©2026 Castle Biosciences 8 Answering clinical questions to guide care along the patient journey 1. Collaboration and license agreement with SciBase Holding AB (“SciBase”) announced in June 2025 RESCUE/ PREVENTION DIFFERENTIAL DIAGNOSTIC SUPPORT RISK STRATIFICATION THERAPY SELECTION GUIDANCE MRD=minimal residual disease SCREENING SUPPORT Dermatology Ophthalmology Pipeline test to diagnose GI disease (non-endoscopic cell collection device) Pipeline test to diagnose GI disease (non-endoscopic cell collection device) SciBase Collaboration Atopic Dermatitis (AD) Flares Pipeline1 Gastroenterology
©2026 Castle Biosciences 9 Clinical portfolio and pipeline tests Franchise Test Indication/Utility ~U.S. TAM1/Use Population Discovery Development Commercial Dermatology Cutaneous melanoma/ risk of sentinel lymph node positivity, recurrence & metastasis ~$540M/ 130k patients w/ invasive CM Cutaneous squamous cell carcinoma/ risk of metastasis & local recurrence; likelihood of benefit from ART ~$820M/ 200k patients with high-risk SCC Ambiguous melanocytic lesions/ malignant potential ~$600M/ 300k patients w/ ambiguous lesions Atopic dermatitis/ therapy guidance ~$33B/ ~10 million patients ages 12+ in U.S. one- year prevalence SciBase collaboration pipeline test Atopic dermatitis/ prediction of flares Gastroenterology Barrett’s esophagus/ risk of progression to high-grade dysplasia or esophageal adenocarcinoma ~$1B Pipeline test (non-endoscopic collection device) GI disease/ diagnostic test Ophthalmology Uveal melanoma/ risk of metastasis ~$10M 1. U.S. TAM= Total addressable market based on estimated patient population assuming average reimbursement rate among all payors.
©2026 Castle Biosciences 10 DecisionDx-Melanoma DERMATOLOGY Provides comprehensive, personalized, genomic tumor information to guide management for patients with cutaneous melanoma demonstrated change in management for 1 of 2 patients tested3 ~231,900 patients with a clinical DecisionDx- Melanoma order from ~16,700 clinicians4 50% Clinical Validity, Utility and Demonstrated Patient Outcomes Demonstrated clinical validity, utility and impact, backed by 58 peer-reviewed publications, including two publications (Bailey et al. 2023 and Dhillon et al. 2023) demonstrating an association with testing and improved patient outcomes SLNB Guidance and Patient Outcomes1,2 DecisionDx-Melanoma successfully identified patients with T1 tumors with a low risk of SLN positivity who can safely forgo SLNB while maintaining high survival rates in a prospective multicenter study and can reduce SLNB- associated complications and healthcare costs. 1. Marks, The i31-GEP identifies patients with T1 cutaneous melanoma who can safely avoid sentinel lymph node biopsy: Results from a prospective, multicenter study. Video abstract presented at: 2024 American Society for Dermatologic Surgery (ASDS) Annual Meeting; 2. Guenther JM, et al. Patients who forego sentinel lymph node biopsy after 31-GEP testing are not harmed: A prospective, multicenter analysis. Poster presented at: 20th European Association of Dermato-Oncology (EADO) Congress; 3. Dillon et al. 2022; 4. Data as of December 31, 2025; 5. U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors. SLN(B)=sentinel lymph node (biopsy) ~$540M Estimated U.S. TAM5
©2026 Castle Biosciences 11 Individual risk of SLNB positivity Individual risk of recurrence ? 31-GEP Class Score Ulceration Breslow thickness Age Mitotic rate Ulceration Age Breslow thickness Mitotic rate SLN status Tumor location Collaborative study with the National Cancer Institute’s SEER Program Registries is the largest real- world study of GEP testing in melanoma (n=4,687): • SEER cohort of unselected, prospectively tested patients shows improved survival for patients tested with DecisionDx-Melanoma compared to untested patients with 29% lower 3-year melanoma-specific and 17% lower 3-year overall mortality, and • DecisionDx-Melanoma provided significant, independent risk stratification of patients with cutaneous melanoma SLN- patients with a high-risk DecisionDx-Melanoma result had routine imaging surveillance added to their treatment plan. These patients: • Had their recurrence detected ~10 months earlier, with 62% lower tumor burden • Were more likely to start immunotherapy when offered (76.3% vs 67.9%) • Saw improved overall survival outcomes at 45 months (86.8% vs 75%) Whitman et al. JCO Precis. Oncol. 2021; Jarell et al. J. Am. Acad. Dermatol. 2022 Bailey et al. JCO Precis. Oncol. 2023; Dhillon et al. Arch Dermatol Res. 2023 “Patients who received routine imaging after high- risk GEP test scores had an earlier recurrence diagnosis with lower tumor burden, leading to better clinical outcomes.” Clinical use of DecisionDx-Melanoma is associated with improved patient survival DecisionDx-Melanoma provides precise, personalized risk prediction for two critical clinical questions
©2026 Castle Biosciences 12 Evidence from prospective studies supporting DecisionDx-Melanoma demonstrates: DecisionDx- Melanoma low-risk, Class 1A patients who forego a SLNB have high recurrence-free survival DecisionDx- Melanoma low-risk test results are associated with low SLNB positive outcomes Physicians are using DecisionDx-Melanoma to inform clinical decisions about sentinel lymph node biopsy (SLNB) and performing fewer SLNBs Guenther, JM, et al. Society of Surgical Oncology SSO 2024 Annual Meeting. Ann Surg Oncol 31 (Suppl 1), S32 (2024). Yamamoto et al. CMRO. 2023. Guenther et al. World J. Surg. Oncol. 2025 1 2 3
©2026 Castle Biosciences 13 TissueCypher GASTROENTEROLOGY A leading risk-stratification test designed to predict risk of progression to esophageal cancer in patients with Barrett’s esophagus Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 17 peer-reviewed publications demonstrating the ability and performance of the test in risk-stratifying patients with Barrett’s esophagus to guide risk- appropriate treatment decisions Recognition from AGA 2024 Clinical Practice Guideline acknowledges that individuals who may be at increased risk of progression to esophageal cancer might be identified using tissue-based biomarkers, particularly TissueCypher 2022 Recognized in the Clinical Practice Update on New Technology and Innovation for Surveillance and Screening in Barrett’s Esophagus as a tool that may be used by physicians to risk stratify non-dysplastic patients ~415,000 patients receiving upper GI endoscopies per year who meet intended use criteria for TissueCypher 1 in 40 patients progress to esophageal cancer within 5 years (among BE patients)1 ~$1B 1. Shaheen et al. Gastroenterology 2000; 2. U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors. Estimated U.S. TAM2
©2026 Castle Biosciences 14 TissueCypher provides individualized 5-year risk of progression to HGD or EAC Low RiskHigh Risk • High Risk score enables increased surveillance or early intervention to prevent cancer1 • Low Risk score minimizes over-treatment and supports extension of surveillance intervals to guideline recommendations1 Indicated for NDBE, IND, and LGD 1. Rubenstein JH, et al. Gastroenterology. 2024.
©2026 Castle Biosciences 15 TissueCypher provides independent prediction of progression n=699 patients1-6, 150 incident progressors, 40 prevalent cases, 509 non-progressors No significant risk stratification 62% progressors detected 7.8x ↑ risk 2.7x ↑ risk 1. Critchley-Thorne RJ, et al. Cancer Epidemiol Biomarkers Prev. 2016; 2. Critchley-Thorne RJ, et al. Cancer Epidemiol Biomarkers Prev. 2017; 3. Davison JM, et al. Am J Gastroenterol. 2020; 4. Frei NF, et al. Clin Transl Gastroenterol. 2020; 5. Frei NF, et al. Am J Gastroenterol. 2021; 6. Davison JM, et al. Clin & Transl Gastroenterol. 2023. Real world histologic grading TissueCypher risk class
©2026 Castle Biosciences 16 AdvanceAD-Tx DERMATOLOGY A non-invasive molecular test that is designed to detect the underlying immune biology of atopic dermatitis (AD) that is driving an individual patient’s AD and thus helps to guide systemic treatment decision making in patients with moderate- to-severe AD Validated in Real-World Patients • The AdvanceAD-Tx test has been clinically validated in patients 12 years and older with moderate-to-severe AD. The clinical validation study included both systemic treatment naïve patients and those who were on a systemic treatment but considering a switch in therapy. • The test can be ordered at any point in the patient’s treatment journey and provides valuable molecular insight to help guide therapy-class selection. Ordering the test early may help reduce uncertainty, minimize trial-and-error, and support more timely disease control. ~10m patient population of moderate-to- severe AD patients 12+ year of age, based on one-year prevalance1 ~$33 billion 1. Atopic Dermatitis in America Study: A Cross-Sectional Study Examining the Prevalence and Disease Burden of Atopic Dermatitis in the US Adult Population. DOI:https://doi.org/10.1016/j.jid.2018.08.028. Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. DOI:https://doi.org/10.1016/j.jid.2018.08.028; https://www.census.gov/data/tables/time-series/demo/popest/2020s-national-detail.html 2. https://pmc.ncbi.nlm.nih.gov/articles/PMC11904833/pdf/ActaDV-105-41504.pdf; 3. U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors. of patients who started on an advanced biologic or JAKi switched to another advanced systemic therapy2 ~27% Estimated U.S. TAM3
17©2026 Castle Biosciences Moderate-to- severe AD patient ≥12 years JAK Inhibitor Responder Profile Gene expression profile is associated with a significantly higher clinical benefit from JAK inhibitor treatment Th2 Molecular Profile Gene expression profile is associated with similar clinical benefit regardless of treatment with a Th2-targeted or JAK inhibitor therapy • Quantifies expression of 487 genes from 12 immune, inflammatory and cutaneous pathways associated with AD • Applies a validated neural network algorithm • Guides systemic treatment decision making AdvanceAD-Tx guides systemic treatment choice for patients with moderate-to-severe atopic dermatitis Silverberg JI et al, The 487-gene expression profile test guides systemic therapy selection to improve outcomes for patients with atopic dermatitis: Results from a prospective trial. J Am Acad Dermatol, 2026 Feb, Article in Press.
©2026 Castle Biosciences 18 Data from the IDENTITY Study Patients with JAKi Responder Profile who are treated with a JAK inhibitor therapy, compared to those treated with a Th2-targeted therapy achieve the following by 3 months: Achieved a higher rate of EASI-90 (45.5% vs 8.3%, p=0.021) More likely to report “no itch” by three months (45.5% vs. 8.3%, p=0.021) More likely to remain flare-free during treatment (54.5% vs. 16.7%, p=0.041) Reached EASI-90 3.8 times faster (p=0.049) More likely to achieve a validated investigator global assessment score of clear (vIGA-AD 0, 36.4% vs 0%, p=0.006) Silverberg JI et al, The 487-gene expression profile test guides systemic therapy selection to improve outcomes for patients with atopic dermatitis: Results from a prospective trial. J Am Acad Dermatol, 2026 Feb, Article in Press. Eczema area and severity index improvement of 90% =EASI90.
©2026 Castle Biosciences 19 Financials
©2026 Castle Biosciences 20 Fourth Quarter and Year-end 2025 Financial Highlights Total Revenue Cash Position4 Operating Cash Flow Total Report Volume Adjusted Gross Margin1,2 Adjusted EBITDA3 $87.0M $299.5M$26.9M27,236 77.6% $11.5M 1. Adjusted Gross Margin is a non-GAAP measure. See Non-GAAP reconciliations at the end of this presentation for a reconciliation of Adjusted Gross Margin to its most closely comparable GAAP measure. 2. Calculated as Adjusted Gross Margin (Non-GAAP) divided by Adjusted Revenues (Non-GAAP) 3. Adjusted EBITDA is a non-GAAP measure. See non-GAAP reconciliations at the end of this presentation for a reconciliation of Adjusted EBITDA to its most closely comparable GAAP measure. 4. As of December 31, 2025; includes Cash, Cash Equivalents & Marketable Investment Securities Track record of consistent execution and strong business fundamentals $344.2M $299.5M$64.3M105,053 79.8% $44.0M 4Q25 2025
©2026 Castle Biosciences 21 Fourth Quarter and Year-end 2025 Test Volume Results 4Q25 4Q24 2025 2024 Total Test Reports 27,236 24,071 105,053 96,071 DecisionDx-Melanoma 10,022 8,672 39,083 36,008 TissueCypher 11,803 6,672 39,014 20,956 DecisionDx-SCC1 3,971 4,299 17,294 16,348 MyPath Melanoma 1,045 879 4,288 3,909 DecisionDx-UM 395 424 1,769 1,699 IDgenetix2 0 3,125 3,605 17,151 1. Affecting fourth quarter and twelve months ended December 31, 2025 test report volume was the change in Medicare coverage effective April 24, 2025, and re-focus of our commercial efforts. 2. The Company discontinued its IDgenetix test offering effective May 2025.
©2026 Castle Biosciences 22 A disciplined approach to capital allocation Commercial optimization Focused R&D efforts to build evidentiary support and develop tests Strategic opportunities, including within our current therapeutic areas
©2026 Castle Biosciences 23 Well positioned for continued value creation Drive robust test volume growth Maintain strong Adjusted Gross Margin Maintain strong balance sheet Follow disciplined capital allocation
©2026 Castle Biosciences 24 Appendix
©2026 Castle Biosciences 25 DecisionDx-SCC DERMATOLOGY Identifies the risk of metastasis in patients with squamous cell carcinoma (SCC) and one or more risk factors Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 24 peer-reviewed publications, including data showing that DecisionDx- SCC can significantly impact patient management plans in a risk-appropriate manner within established guidelines Real-World Use Framework Several published studies in 2024 supported the use of DecisionDx-SCC to predict likelihood of benefit from adjuvant radiation therapy (ART); two of these studies represent the largest1 and second largest2 studies completed to date to evaluate the effectiveness of ART in SCC Estimated U.S. TAM4 ~200,000 ~77% ~$820M patients diagnosed annually with SCC and classified as high risk in the U.S. of clinicians ordering DecisionDx-SCC also ordered DecisionDx- Melanoma3 1. Arron et al. International Journal of Radiation Oncology, Biology & Physics 2024; 2. Ruiz et al. Future Oncology 2024; 3. twelve-months ended December 31, 2025; 4. U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors; 5. Data as of December 31, 2025. patients with a clinical DecisionDx- SCC order from ~7,380 clinicians5 ~59,250
©2026 Castle Biosciences 26 DecisionDx-SCC addresses three critical clinical questions for high-risk SCC patients DecisionDx-SCC Class results predict an SCC patient’s individual risk of metastasis, local recurrence and individual benefit from adjuvant radiation therapy (ART) *Treated with Mohs surgery with no residual disease (R0) Overall Event Rate: 13.2%, n=897 1 What is my SCC patient’s risk of regional or distant metastasis? Low 6.5% Higher 19.4% Highest 45.9% Overall Event Rate: 8.9%, n=414 2 What is my NCCN high risk SCC patient’s risk of local recurrence*? Low 5.8% Higher 14.5% Highest 28.6% 3 Is my SCC patient likely to benefit from adjuvant radiation therapy (ART)? No discernible benefit Potential benefit Likely to benefit
©2026 Castle Biosciences 27 DecisionDx-SCC may identify patients who benefit most from ART to control metastatic disease progression • A Class 2B result reflects a significant decrease in median risk of metastatic disease progression between resampled cohorts that did and did not receive ART M E D IA N M E T P R O G R E S S R A T E ( % ) TIME (YEARS) 1.00 0.75 0.50 0.25 0.0 0 0 1 2 3 4 5 MEDIAN RISK OF METASTATIC DISEASE PROGRESSION ART: Class 1 noART: Class 1 noART: Class 2A ART: Class 2A ART: Class 2B noART: Class 2B • A Class 1 or Class 2A result did not reflect a significant decrease in median risk of metastatic disease progression between resampled cohorts that did and did not receive ART 100 5 5
©2026 Castle Biosciences 28 MyPath Melanoma DERMATOLOGY Aids in the diagnosis and management for patients with ambiguous melanocytic lesions Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 20 peer-reviewed publications demonstrating the performance and utility of the test in providing objective information to aid in diagnosis in ambiguous melanocytic lesions Guideline Support • National Comprehensive Cancer Network guidelines for cutaneous melanoma in the principles for molecular testing • American Society of Dermatopathology in the Appropriate Use Criteria for ancillary diagnostic testing • American Academy of Dermatology guidelines of care for the management of primary cutaneous melanoma Estimated U.S. TAM2 ~300,000 patients each year present with a diagnostically ambiguous lesion 50,000+ lesions tested clinically1 ~$600M 1. As of December 31, 2025; 2. U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors.
©2026 Castle Biosciences 29 DecisionDx-UM OPHTHALMOLOGY The standard of care for evaluating metastatic risk in uveal melanoma Standard of Care • Utilized in approximately 80% of newly diagnosed patients • Included in NCCN Guidelines and considered standard of care peer-reviewed publications ~8 in 10 ~2,000 30+ patients diagnosed in the U.S. annually patients diagnosed with UM in the U.S. receive the test as part of their diagnostic workup Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 39 peer-reviewed publications, which included more than 5,500 patients, representing the largest body of evidence for a molecular prognostic test in this field Data as of December 31, 2025
©2026 Castle Biosciences 30 Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of Adjusted Revenues and Adjusted Gross Margin, which are non-GAAP financial measures. See "Use of Non- GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use of non-GAAP financial measures. (In thousands) Three months ended Dec. 31, 2025 Sep. 30, 2025 Jun. 30, 2025 Mar. 31, 2025 Dec. 31, 2024 Adjusted Revenues Net revenues (GAAP) $87,010 $83,043 $86,188 $87,988 $86,311 Revenue associated with test reports delivered in prior periods (5,134) (2,498) (6) (787) (491) Adjusted Revenues (Non-GAAP) $81,876 $80,545 $86,182 $87,201 $85,820 Adjusted Gross Margin Gross margin (GAAP)1 $66,419 $62,063 $66,601 $43,280 $65,788 Amortization of acquired intangible assets 2,276 2,276 1,961 28,325 4,340 Revenue associated with test reports delivered in prior periods (5,134) (2,498) (6) (787) (491) Adjusted Gross Margin (Non-GAAP) $63,561 $61,841 $68,556 $70,818 $69,637 Gross Margin percentage (GAAP)2 76.3% 74.7% 77.3% 49.2% 76.2% Adjusted Gross Margin percentage (Non-GAAP)3 77.6% 76.8% 79.5% 81.2% 81.1%
©2026 Castle Biosciences 31 Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of Adjusted EBITDA, which is a non-GAAP financial measure. See "Use of Non-GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use of non-GAAP financial measures. (In thousands) Three months ended Dec. 31, 2025 Sep. 30, 2025 Jun. 30, 2025 Mar. 31, 2025 Dec. 31, 2024 Adjusted EBITDA Net (loss) income $(2,332) $(501) $4,523 $(25,848) $9,590 Interest income (2,896) (2,833) (2,944) (3,099) (3,372) Interest expense 24 24 21 17 92 Income tax (benefit) expense (382) 115 (4,666) (423) (1,705) Depreciation and amortization expense 3,777 3,816 3,414 29,764 5,768 Stock-based compensation expense 11,406 12,100 11,208 11,179 11,439 Net losses (gains) on equity securities 1,855 (3,561) (1,185) 1,425 (555) Adjusted EBITDA (Non-GAAP) $11,452 $9,160 $10,371 $13,015 $21,257
©2026 Castle Biosciences 32 Thank You
FAQ
How did Castle Biosciences (CSTL) perform financially in 2025?
Castle Biosciences grew revenue modestly but returned to a net loss in 2025. Net revenues reached $344.2 million, up 4% from 2024, while the company reported a net loss of $24.2 million versus prior-year net income of $18.2 million, pressured by amortization and reimbursement changes.
What were Castle Biosciences’ key test volume trends for 2025?
Core test volumes grew strongly in 2025 for Castle Biosciences. Total test reports for DecisionDx-Melanoma and TissueCypher increased 37% year over year. TissueCypher Barrett’s Esophagus test reports rose to 39,014 from 20,956, and DecisionDx-Melanoma volumes increased to 39,083 from 36,008.
How did Castle Biosciences’ margins and Adjusted EBITDA change in 2025?
Margins and Adjusted EBITDA weakened compared with 2024. Gross margin was 69% and Adjusted Gross Margin 80%, down from 79% and 82%. Adjusted EBITDA declined to $44.0 million from $75.0 million, affected by lower DecisionDx-SCC revenue and a one-time $20.1 million amortization acceleration.
What is Castle Biosciences’ cash position and cash flow as of year-end 2025?
Castle Biosciences ended 2025 with a strong liquidity position. As of December 31, 2025, cash, cash equivalents and marketable investment securities totaled $299.5 million. Net cash provided by operating activities for the year was $64.3 million, roughly in line with $64.9 million generated in 2024.
What guidance did Castle Biosciences provide for 2026 revenue?
The company expects relatively stable revenue in 2026. Castle Biosciences anticipates generating between $340 million and $350 million in total revenue, compared with 2025 net revenues of $344.2 million, as it continues to drive adoption of its core dermatology and gastroenterology tests and AdvanceAD-Tx.
How did Castle Biosciences perform in the fourth quarter of 2025?
Fourth-quarter 2025 results showed flat revenue and a small loss. Net revenues were $87.0 million, up 1% from $86.3 million a year earlier. The company reported a net loss of $2.3 million versus net income of $9.6 million in the prior-year quarter, while operating cash flow improved.
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[10-K] CASTLE BIOSCIENCES INC Files Annual Report