Delivered Q1 2026 revenue of $83.7 million
Q1 2026 total test reports for our core revenue drivers (DecisionDx$(R)$ -Melanoma, TissueCypher(R) ) 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.
"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
-- Revenues were $83.7 million, compared to $88.0 million in the first
quarter of 2025. Affecting first quarter 2026 revenue was the change in
DecisionDx-SCC Medicare coverage effective April 24, 2025, the re-focus
of our commercial efforts, as well as the discontinuation of IDgenetix in
May 2025.
-- Revenues for our non-dermatologic tests were $42.6 million,
compared to $25.0 million during the same period in 2025.
Core revenue drivers:
-- First quarter 2026 total test reports for our core revenue drivers
(DecisionDx-Melanoma, TissueCypher) increased 36% over the first quarter
of 2025:
-- DecisionDx-Melanoma test reports delivered in the quarter were
10,021, compared to 8,621 in the first quarter of 2025.
-- TissueCypher Barrett's Esophagus test reports delivered in the
quarter were 11,745, compared to 7,432 in the first quarter of
2025.
Additional tests:
-- DecisionDx-SCC test reports delivered in the quarter were 3,702,
compared to 4,375 in the first quarter of 2025.
-- MyPath(R) Melanoma test reports delivered in the quarter were 973,
compared to 926 in the first quarter of 2025.
-- DecisionDx(R)-UM test reports delivered in the quarter were 492,
compared to 470 in the first quarter of 2025.
-- Gross margin was 73%, and Adjusted Gross Margin was 76%, compared to 49%
and 81%, respectively, for the same periods in 2025. Affecting first
quarter 2025 gross margin was the one-time adjustment of an acceleration
of amortization expense of approximately $20.1 million.
-- Net cash used in operations was $22.1 million, compared to net cash used
in operations of $6.0 million for the same period in 2025. First quarter
2026 cash use reflects payout of employee annual cash bonuses as well as
certain health care benefit payments, totaling $28.8 million, that are
not expected to recur during the remainder of 2026.
-- Net loss, which includes non-cash stock-based compensation expense of
$9.8 million, was $14.5 million, compared to net loss of $25.8 million
for the same period in 2025.
-- Net loss per share, Basic and Diluted, was $0.49, compared to net loss
per share, Basic and Diluted of $0.90 and Adjusted Net Loss per Share,
Basic and Diluted, of $0.20, for the same period in 2025.
-- Adjusted EBITDA was $(5.1) million, compared to $13.0 million for the
same period in 2025.
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
-- The Company presented new data at the 2026 American Academy of
Dermatology Annual Meeting demonstrating that its DecisionDx-Melanoma
test refines mortality risk within American Joint Committee on Cancer
(AJCC) stages for patients with cutaneous melanoma $(CM)$. The data showed
that DecisionDx-Melanoma identifies clinically meaningful differences in
mortality risk among patients within the same stage, which may help
clinicians more confidently escalate care for higher-risk patients while
avoiding unnecessary interventions in those at lower risk of poor
outcomes. See the Company's news release from March 27, 2026, for more
information.
-- The Company also announced new data from a prospective, multicenter study
evaluating DecisionDx-Melanoma's integrated sentinel lymph node biopsy
(i31-SLNB) test result. The study data confirmed that the i31-SLNB
accurately predicts SLN positivity and identifies low-risk patients who
may safely consider forgoing SLNB while maintaining favorable long-term
outcomes. These results expanded upon earlier publications from the same
prospective, multicenter clinical study and further strengthened the
growing body of evidence supporting the role of DecisionDx-Melanoma in
guiding SLNB decision-making. The paper, available in Future Oncology,
confirmed that DecisionDx-Melanoma's i31-SLNB identifies patients below
the 5% National Comprehensive Cancer Network(R) (NCCN) threshold for
forgoing sentinel lymph node biopsy and outperforms traditional staging
criteria and other predictive gene expression profile (GEP) tests. See
the Company's news release from March 9, 2026, for more information.
-- The Company presented new data at the European Congress
of Dermato-Oncology (EADO) Congress and the American College of Mohs
Surgery (ACMS) Annual Meeting demonstrating that its DecisionDx-Melanoma
test provides independent, personalized prognostic information beyond
AJCC staging, identifying biologically high-risk patients--including
those with thin and early-stage disease--and supporting more precise,
risk-aligned clinical management. See the Company's news release from
April 21, 2026, for more information.
-- The Company is supporting a series of initiatives across the country
during May in recognition of Skin Cancer Awareness Month, including
advocacy walks, community skin cancer screenings and patient education
programs in collaboration with leading patient advocacy organizations.
These efforts are aimed at expanding access to early detection, education
and community-based resources to help prevent skin cancer and improve
patient outcomes. See the Company's news release from May 5, 2026, for
more information.
Gastroenterology
-- The Company announced that new data from Mayo Clinic researchers,
presented at Digestive Disease Week(R), demonstrate that its TissueCypher
test improves risk stratification and informs real-world management
decisions for patients with Barrett's esophagus, including influencing
surveillance intervals in more than half of patients and enabling more
personalized, risk-aligned care. See the Company's news release from May
4, 2026, for more information.
Dermatology - Atopic Dermatitis
-- The Company announced the publication of a prospective, multicenter
clinical validation study in the Journal of the American Academy of
Dermatology (JAAD) demonstrating that its AdvanceAD-Tx test can identify
patients with moderate-to-severe atopic dermatitis who are significantly
more likely to achieve greater and faster clinical responses when treated
with a Janus kinase inhibitor compared to T helper type 2-targeted
therapies. See the Company's news release from February 19, 2026, for
more information.
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.
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