CSTL · Castle Biosciences, Inc.

Castle Biosciences delivered Q1 2026 revenue of $83.7 million, down from $88.0 million in Q1 2025, primarily due to the DecisionDx-SCC Medicare coverage change effective April 24, 2025, refocused commercial efforts, and IDgenetix discontinuation in May 2025. Despite the decline, non-dermatologic test revenues grew to $42.6 million from $25.0 million, highlighting strength in other areas. Core revenue drivers shone with total test reports for DecisionDx-Melanoma and TissueCypher surging 36% year-over-year, driven by 16% growth in DecisionDx-Melanoma (10,021 reports) and 58% in TissueCypher (11,745 reports), with March marking a record month for both. CEO Derek Maetzold emphasized the team's execution and momentum in these products. Gross margins improved markedly to 73% GAAP and 76% adjusted from 49% and 81% last year, the prior period affected by a $20.1 million one-time amortization acceleration. Net loss narrowed to $14.5 million ($0.49/share) from $25.8 million ($0.90/share), with Adjusted EBITDA at $(5.1) million versus $13.0 million. Cash usage of $22.1 million reflected one-time bonus and benefit payments of $28.8 million not expected to recur. The company raised its full-year 2026 revenue guidance to $345-355 million, signaling confidence amid robust clinical evidence expansion for DecisionDx-Melanoma, including new prospective study data reinforcing its SLNB decision-making utility. Balance sheet remains solid with $261.7 million in cash and equivalents as of March 31, 2026.