Castle Biosciences
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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.
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Q1 2026 earnings summary6 May, 2026

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.

Novitas LCD impact on DecisionDx-SCC volume
Basis for the $33B AdvanceAD-Tx TAM estimate
i31-SLNB data and NCCN 5% threshold alignment
DecisionDx-SCC revenue impact from coverage change
Drivers of the $28.8M non-recurring cash outlay
TissueCypher impact on surveillance intervals
Explain the shift to non-dermatologic revenue
AdvanceAD-Tx order volume in limited launch
Update on the OIG healthcare claims subpoena
Explain the AdvanceAD-Tx reimbursement strategy
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