Castle Biosciences Reports First Quarter 2026 Results

PR Newswire

FRIENDSWOOD, Texas, May 6, 2026

Delivered Q1 2026 revenue of $83.7 million
Q1 2026 total test reports for our core revenue drivers (DecisionDx®-Melanoma, TissueCypher®) increased 36% over Q1 2025
Raising full-year 2026 revenue guidance to $345-355 million from $340-350 million
Conference call and webcast today at 4:30 p.m. ET

FRIENDSWOOD, Texas, May 6, 2026  /PRNewswire/ -- Castle Biosciences, Inc. (Nasdaq: CSTL), a company improving health through innovative tests that guide patient care, today announced its financial results for the first quarter ended March 31, 2026.

Castle Biosciences (PRNewsfoto/Castle Biosciences, Inc.)

"The Castle Biosciences team delivered outstanding results to start 2026, delivering $83.7 million in revenue," said Derek Maetzold, president and chief executive officer of Castle Biosciences. "I thank our team for their dedication and focus, which translates directly to our performance. Our momentum this quarter reflects our robust execution and the strength of our core revenue drivers, with both DecisionDx-Melanoma and TissueCypher achieving double digit year-over-year test volume growth, 16% and 58%, respectively. As a result of our first quarter performance and continued confidence in the business, we are raising our 2026 total revenue guidance to $345-355 million, compared to the previously provided guidance of $340-350 million.

"In addition, during the quarter we expanded the body of evidence supporting our market-leading DecisionDx-Melanoma test. Specifically, we announced new data from a prospective, multicenter, U.S. based study demonstrating that patients with a less than 5% predicted risk of sentinel lymph node positivity had an actual positivity rate of just 2.6%, reinforcing DecisionDx-Melanoma's ability to guide sentinel lymph node biopsy decision-making in line with guideline thresholds. Our substantial body of evidence is a key driver of adoption and an important differentiator for DecisionDx-Melanoma and our innovative test portfolio more broadly, reinforcing our position of strength as we continue to execute across the business."

First Quarter Ended Mar. 31, 2026, Financial and Operational Highlights

Core revenue drivers:

Additional tests:

Cash, Cash Equivalents and Marketable Investment Securities
As of Mar. 31, 2026, the Company's cash, cash equivalents and marketable investment securities totaled $261.7 million.

2026 Outlook
Castle Biosciences is raising its guidance for anticipated total revenue in 2026. The Company now anticipates generating between $345-355 million in total revenue in 2026, compared to the previously provided guidance of between $340-350 million.

First Quarter and Recent Accomplishments and Highlights

Dermatology - Skin Cancer

Gastroenterology

Dermatology - Atopic Dermatitis

Conference Call and Webcast Details
Castle Biosciences will hold a conference call on Wednesday, May 6, 2026, at 4:30 p.m. Eastern time to discuss its first quarter 2026 results and provide a corporate update.

A live webcast of the conference call can be accessed here: https://events.q4inc.com/attendee/621816679 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 May 27, 2026.

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 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: interest income, interest expense, income tax benefit or expense, depreciation and amortization expense, stock-based compensation expense and net (gains) losses on equity securities. Adjusted Net Loss per Share, Basic and Diluted, excludes a one-time adjustment of an acceleration of amortization expense for our IDgenetix test from net loss.

We use Adjusted Revenues, Adjusted Gross Margin, Adjusted EBITDA and Adjusted Net Loss 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 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 Net Loss 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 or net loss 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, Esopredict, 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 $345-355 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, (iii) provide clarity in overall risk beyond histology, and (iv) guide sentinel lymph node biopsy decision-making, including through the i31-SLNB test result, by accurately predicting SLN positivity and identifying low-risk patients who may safely consider forgoing SLNB; the ability of DecisionDx-SCC to (i) predict individual risk of metastasis, benefit from ART and risk of LR, (ii) provide comprehensive results to support tailored post-surgical management and treatment pathway recommendations and (iii) provide actionable decision points based on individual patient risk; the anticipated success of our launch of AdvanceAD-Tx; and Castle's ability to achieve near- and long-term success and the continued growth of our portfolio. The words "anticipate," "can," "could," "expect," "goal," "guidance," "may," "plan," "potentially," "providing," "upcoming" 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, 2025 and our Quarterly Report on Form 10-Q for the quarter ended March 31, 2026, 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.

 

 CASTLE BIOSCIENCES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS

(UNAUDITED)

(in thousands, except per share data)



Three Months Ended
March 31,


2026


2025

NET REVENUES

$      83,679


$      87,988

OPERATING EXPENSES




Cost of sales (exclusive of amortization of acquired intangible assets)

20,533


16,383

Research and development

14,428


12,588

Selling, general and administrative

64,899


58,620

Amortization of acquired intangible assets

2,226


28,325

Total operating expenses, net

102,086


115,916

Operating loss

(18,407)


(27,928)

Interest income

2,545


3,099

Net gains (losses) on equity securities

2,022


(1,425)

Interest expense

(134)


(17)

Other loss

(439)


Loss before income taxes

(14,413)


(26,271)

Income tax expense (benefit)

109


(423)

Net loss

$     (14,522)


$     (25,848)





Loss per share, basic and diluted

$        (0.49)


$        (0.90)





Weighted-average shares outstanding, basic and diluted

29,889


28,609

 

Stock-Based Compensation Expense 

Stock-based compensation expense is included in the condensed consolidated statements of operations as follows (in
thousands): 



Three Months Ended
March 31,


2026


2025


(unaudited)

Cost of sales (exclusive of amortization of acquired intangible assets)

$        1,257


$        1,456

Research and development

1,443


1,895

Selling, general and administrative

7,076


7,828

Total stock-based compensation expense

$        9,776


$      11,179

 

CASTLE BIOSCIENCES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS

(UNAUDITED)

(in thousands)



Three Months Ended
March 31,


2026


2025

Net loss

$     (14,522)


$     (25,848)

Other comprehensive loss:




Net unrealized loss on marketable investment securities

(330)


(99)

Comprehensive loss

$     (14,852)


$     (25,947)

 

CASTLE BIOSCIENCES, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

(in thousands)






March 31,
2026


December 31,
2025

ASSETS

(unaudited)



Current Assets




Cash and cash equivalents

$       63,764


$      116,729

Marketable investment securities

197,921


182,776

Accounts receivable, net

42,264


43,382

Inventory

10,461


10,254

Prepaid expenses and other current assets

14,491


7,956

Total current assets

328,901


361,097

Long-term accounts receivable, net

1,921


1,878

Property and equipment, net

100,934


97,443

Operating lease assets

14,424


14,795

Goodwill and other intangible assets, net

97,347


99,574

Other assets – long-term

4,278


3,769

Total assets

$      547,805


$      578,556





LIABILITIES AND STOCKHOLDERS' EQUITY




Current Liabilities




Accounts payable

$       15,038


$        18,711

Accrued compensation

19,111


38,287

Contingent consideration

1,000


1,000

Operating lease liabilities

1,254


1,325

Current portion of long-term debt

1,667


417

Other accrued and current liabilities

10,691


8,937

Total current liabilities

48,761


68,677

Long-term debt

8,399


9,640

Noncurrent portion of contingent consideration

1,500


1,500

Noncurrent operating lease liabilities

25,116


25,217

Noncurrent finance lease liabilities

288


314

Deferred tax liability

2,325


2,335

Total liabilities

86,389


107,683

Stockholders' Equity




Preferred stock


Common stock

30


30

Additional paid-in capital

700,255


694,860

Accumulated deficit

(238,806)


(224,284)

Accumulated other comprehensive (loss) income

(63)


267

Total stockholders' equity

461,416


470,873

Total liabilities and stockholders' equity

$      547,805


$      578,556

 

CASTLE BIOSCIENCES, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

(UNAUDITED)

(in thousands)




Three Months Ended

March 31,


2026


2025

OPERATING ACTIVITIES




Net loss

$      (14,522)


$      (25,848)

Adjustments to reconcile net loss to net cash used in operating activities:




Depreciation and amortization

3,929


29,764

Stock-based compensation expense

9,776


11,179

Net (gains) losses on equity securities

(2,022)


1,425

Deferred income taxes

(10)


(770)

Accretion of discounts on marketable investment securities

(454)


(1,435)

Other

532


30

Change in operating assets and liabilities:




Accounts receivable

1,075


(5,217)

Prepaid expenses and other current assets

(6,667)


(3,364)

Inventory

(207)


1,286

Operating lease assets

371


420

Other assets

(530)


(38)

Accounts payable

3,193


615

Operating lease liabilities

(172)


(526)

Accrued compensation

(19,176)


(14,698)

Other accrued and current liabilities

2,755


1,141

Net cash used in operating activities

(22,129)


(6,036)





INVESTING ACTIVITIES




Purchases of marketable investment securities

(55,136)


(48,431)

Proceeds from maturities of marketable investment securities

39,100


36,300

Purchases of debt securities classified as held-to-maturity


(5,569)

Proceeds from sale of equity securities

2,681


Purchases of property and equipment

(12,455)


(4,740)

Proceeds from sale of property and equipment

7


9

Net cash used in investing activities

(25,803)


(22,431)





FINANCING ACTIVITIES




Proceeds from exercise of common stock options

322


18

Payment of employees' taxes on vested restricted stock units and performance-based restricted
stock units

(6,598)


(2,515)

Proceeds from contributions to the employee stock purchase plan

1,267


970

Repayment of principal portion of finance lease liabilities

(24)


(26)

Net cash used in financing activities

(5,033)


(1,553)





NET CHANGE IN CASH AND CASH EQUIVALENTS

(52,965)


(30,020)

Beginning of period

116,729


119,709

End of period

$        63,764


$        89,689

 

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 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
March 31,

(in thousands, except per share data)

2026


2025

Adjusted Revenues




Net revenues (GAAP)

$      83,679


$      87,988

Revenue associated with test reports delivered in prior periods

551


(787)

Adjusted Revenues (Non-GAAP)

$      84,230


$      87,201





Adjusted Gross Margin




Gross margin (GAAP)1

$      60,920


$      43,280

Amortization of acquired intangible assets

2,226


28,325

Revenue associated with test reports delivered in prior periods

551


(787)

Adjusted Gross Margin (Non-GAAP)

$      63,697


$      70,818





Gross Margin percentage (GAAP)2

72.8 %


49.2 %

Adjusted Gross Margin percentage (Non-GAAP)3

75.6 %


81.2 %





Adjusted Net Loss Per Share, Basic and Diluted




Net loss (GAAP)

$   (14,522)


$   (25,848)

Amortization of acquired intangible assets4


20,099

Adjusted Net Loss (Non-GAAP)

$   (14,522)


$     (5,749)





Weighted-average shares outstanding, basic and diluted:

29,889


28,609





Net loss per share, basic and diluted (GAAP)5

$       (0.49)


$       (0.90)

Adjusted Net Loss Per Share, Basic and Diluted (Non-GAAP)6

$       (0.49)


$       (0.20)














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 (GAAP) divided by weighted-average shares outstanding, basic and diluted.


6.

Calculated as Adjusted Net Loss (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
March 31,

(in thousands)

2026


2025

Adjusted EBITDA




Net loss

$     (14,522)


$     (25,848)

Interest income

(2,545)


(3,099)

Interest expense

134


17

Income tax expense (benefit)

109


(423)

Depreciation and amortization

3,929


29,764

Stock-based compensation expense

9,776


11,179

Net (gains) losses on equity securities

(2,022)


1,425

Adjusted EBITDA (Non-GAAP)

$       (5,141)


$      13,015

 

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SOURCE Castle Biosciences, Inc.