Castle Biosciences Stock Earnings Reports

Castle Biosciences reported a strong start to 2026 with Q1 revenue of $83.7 million and notable volume growth across its core tests. DecisionDx‑Melanoma delivered 10,021 reports in Q1 (16% YoY) with a record month in March and management reiterates mid‑ to high‑single digit volume growth for 2026. TissueCypher grew 58% YoY (11,745 reports) and also hit record monthly volumes in March, with management expecting full‑year TissueCypher growth approaching ~50% (adding a similar number of tests in 2026 as in 2025). AdvanceAD‑Tx (atopic dermatitis) remains in limited access; ~650 orders were received in Q1 and clinical validation data published supporting differential response to JAK inhibitors versus Th2 biologics. Management expects clearer reimbursement visibility for AdvanceAD‑Tx by end of Q3 2026 and continues work on an FDA submission for melanoma in 2026.

Financially, Castle raised 2026 revenue guidance to $345–$355 million (from $340–$350M) and reported a Q1 adjusted gross margin of ~75.6% (GAAP gross margin 72.8%). Net loss improved to $14.5M in Q1 (vs. $25.8M y/y); adjusted EBITDA was negative $5.1M (impacted by prior year noncash accelerated amortization). Cash, cash equivalents and marketable securities totaled $261.7M as of March 31, 2026. Management reiterated plans to evaluate M&A opportunistically, expects to cover sales needs with fewer than 100 reps across derm and GI, and flagged seasonality in GI procedures as a factor for TissueCypher quarter‑to‑quarter phasing. Key near‑term milestones: more reimbursement clarity for AdvanceAD‑Tx by end of Q3 2026, anticipated FDA submission timing for melanoma in 2026, and ongoing Medicare contractor reconsideration processes for coverage decisions.