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Castle Biosciences (CSTL) investor relations material
Castle Biosciences Q1 2026 earnings summary
Complete event summary combining all related documents: earnings call transcript, report, and slide presentation.Executive summary
Q1 2026 revenue was $83.7 million, with core test volumes up 36% year-over-year, driven by strong growth in DecisionDx-Melanoma and TissueCypher, despite a decline in dermatologic test revenues due to Medicare coverage loss for DecisionDx-SCC.
Full-year 2026 revenue guidance was raised to $345–$355 million, reflecting strong business momentum and increased confidence in top-line growth.
DecisionDx-Melanoma and TissueCypher tests delivered double-digit year-over-year volume growth, with record months in March 2026.
AdvanceAD-Tx test saw 650 orders in Q1, with positive clinician feedback and ongoing limited access rollout.
New clinical data validated DecisionDx-Melanoma's utility in risk stratification and biopsy decision-making, aligning with NCCN guidelines.
Financial highlights
Q1 2026 revenue was $83.7 million, down from $88.0 million in Q1 2025 due to changes in Medicare coverage and discontinued products.
Gross margin improved to 72.8% from 49.2% in Q1 2025; adjusted gross margin was 75.6%–76% vs. 81.2% prior year.
Net loss narrowed to $14.5 million from $25.8 million year-over-year; diluted loss per share improved to $0.49 from $0.90.
Adjusted EBITDA was negative $5.1 million, compared to $13 million in Q1 2025, reflecting prior year one-time amortization.
Cash, cash equivalents, and marketable securities totaled $261.7 million as of March 31, 2026.
Outlook and guidance
2026 revenue guidance raised to $345–$355 million, reflecting high teens to low 20% growth over 2025, excluding certain products.
Management expects continued investment in R&D and commercialization, with expenses projected to rise as new products are developed and launched.
Ongoing efforts to regain Medicare coverage for DecisionDx-SCC could impact future revenues.
AdvanceAD-Tx reimbursement clarity expected by end of Q3 2026; revenue to become material in 2027–2028.
Existing liquidity and anticipated cash from operations expected to fund operations for at least the next 12 months.
- Strong clinical evidence and financial growth support expansion and pipeline innovation.CSTL
Corporate presentation6 May 2026 - Genomic testing enables precise SLNB decisions and improved melanoma outcomes.CSTL
Status update29 Apr 2026 - 2025 saw record revenue, strong governance, and enhanced compensation and ESG policies.CSTL
Proxy filing8 Apr 2026 - Director elections, auditor ratification, and compensation policies up for vote at 2026 meeting.CSTL
Proxy filing8 Apr 2026 - 2025 revenue hit $344.2M with 37% core test growth and strong cash reserves.CSTL
Q4 202526 Feb 2026 - Rapid TissueCypher adoption and strong Q3 results drive raised guidance and future growth.CSTL
Stephens 26th Annual Investment Conference | NASH20243 Feb 2026 - Strong growth in diagnostic testing, with expanding portfolio and positive reimbursement momentum.CSTL
Baird Global Healthcare Conference 20253 Feb 2026 - Q2 revenue up 74% to $87M; 2024 guidance raised amid strong growth and robust cash position.CSTL
Q2 20242 Feb 2026 - Expanding test adoption and sales force, with strong growth and plans to double melanoma penetration.CSTL
Canaccord Genuity 44th Annual Growth Conference & Private Company Showcase 20242 Feb 2026
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