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Castle Biosciences Inc.: Q4 FY2025 earnings call

What management said about Q4 FY2025, from the documents filed with the SEC on 26 February 2026: press release. Guidance figures: 1 new. The quarter’s numbers.

Key takeaways

  • Full-year revenue rose 4%: Full-year revenue was $344.2 million against $332.1 million in 2024. Excluding DecisionDx-SCC and IDgenetix, growth was 34%. Source
  • Net loss against prior-year net income: Full-year net loss was $24.2 million, or $0.83 per share, against net income of $18.2 million in 2024. Adjusted net loss per share was $0.14. Source
  • Non-dermatologic revenue reached $127.9M: Revenue from non-dermatologic tests was $127.9 million in 2025, against $75.1 million. Fourth-quarter non-dermatologic revenue was $38.4 million, against $22.5 million. Source
  • Core test reports rose 37%: Melanoma and TissueCypher reports together were 78,097 in 2025, against 56,964 in 2024, which management described as 37% growth. Source
  • Gross margin fell to 69%: Gross margin was 69% for 2025 against 79%; adjusted gross margin was 80% against 82%. Management cited lost DecisionDx-SCC revenue and the accelerated amortization. Source
  • Cash and securities totaled $299.5M: Cash, cash equivalents and marketable investment securities totaled $299.5 million at December 31, 2025. Source
  • AdvanceAD-Tx limited access launch: AdvanceAD-Tx was launched on limited access for atopic dermatitis. It is designed to identify patients with a JAKi responder profile, per a study published in JAAD. Source

“We exited 2025 with clear leadership across our core dermatologic and gastrointestinal franchises, highlighted by continued momentum in TissueCypher, which achieved 86% test report growth over 2024.”

Derek Maetzold, president and chief executive officer

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue Source2026$340-350 millionNew

What changed from last quarter

  • New guidance: 2026 total revenue guidance of $340-350 million appears in this release; the January preliminary release gave no 2026 figure. Source
  • Guidance raised: 2025 revenue was expected to exceed $340 million, above the earlier guided range of $327-335 million.

Results and growth drivers

  • Full-year revenue rose 4%: Full-year revenue was $344.2 million against $332.1 million in 2024. Excluding DecisionDx-SCC and IDgenetix, growth was 34%. Source
  • Fourth-quarter revenue rose 1%: Fourth-quarter revenue was $87.0 million against $86.3 million. Excluding DecisionDx-SCC and IDgenetix, fourth-quarter growth was 43%. Source
  • Net loss against prior-year net income: Full-year net loss was $24.2 million, or $0.83 per share, against net income of $18.2 million in 2024. Adjusted net loss per share was $0.14. Source
  • Adjusted EBITDA declined: Adjusted EBITDA was $44.0 million for 2025 against $75.0 million. Fourth-quarter adjusted EBITDA was $11.5 million against $21.3 million. Source

Dermatology and gastroenterology franchises

  • Non-dermatologic revenue reached $127.9M: Revenue from non-dermatologic tests was $127.9 million in 2025, against $75.1 million. Fourth-quarter non-dermatologic revenue was $38.4 million, against $22.5 million. Source
  • TissueCypher reports rose to 39,014: Barrett’s Esophagus test reports were 39,014 in 2025, against 20,956 in 2024. Management described this as 86% growth. Source
  • DecisionDx-Melanoma reports rose 9%: DecisionDx-Melanoma test reports were 39,083 in 2025, against 36,008 in 2024. Fourth-quarter reports were 10,022, against 8,672. Source
  • Publications supported both franchises: A consensus paper endorsed DecisionDx-Melanoma as a best-practice tool, and a meta-analysis in the Journal of Clinical Gastroenterology supported TissueCypher risk stratification. Source

“the limited access launch of AdvanceAD-Tx™, which materially expanded our total addressable market”

Derek Maetzold, president and chief executive officer

Test report volumes

  • Core test reports rose 37%: Melanoma and TissueCypher reports together were 78,097 in 2025, against 56,964 in 2024, which management described as 37% growth. Source
  • Fourth-quarter core reports rose 42%: Fourth-quarter core reports were 21,825 (10,022 melanoma and 11,803 TissueCypher), against 15,344 a year earlier. Source
  • DecisionDx-SCC volume mixed: DecisionDx-SCC reports were 17,294 for 2025, up from 16,348, but fell to 3,971 in the fourth quarter from 4,299. Source
  • IDgenetix reports fell after discontinuation: IDgenetix reports were 3,605 in 2025 against 17,151 in 2024; the offering was discontinued effective May 2025. Source
  • MyPath reports rose: MyPath Melanoma reports were 4,288 for 2025 against 3,909 in 2024. DecisionDx-UM reports were 1,769 against 1,699 for the year.

Costs and gross margin

  • Gross margin fell to 69%: Gross margin was 69% for 2025 against 79%; adjusted gross margin was 80% against 82%. Management cited lost DecisionDx-SCC revenue and the accelerated amortization. Source
  • Fourth-quarter gross margin held at 76%: Fourth-quarter gross margin was 76%, the same as the prior year; adjusted gross margin was 78% against 81%. Source
  • Selling and administrative costs rose: Selling, general and administrative expense was $229.3 million for 2025 against $200.0 million; fourth quarter was $56.7 million against $50.0 million. Source
  • Intangible amortization rose: Amortization of acquired intangible assets was $34.8 million for 2025 against $11.1 million, and $2.3 million in the fourth quarter against $4.3 million. Source

“As we look ahead to 2026 and beyond, we believe we are well positioned to continue delivering stockholder value”

Derek Maetzold, president and chief executive officer

Cash flow and balance sheet

  • Operating cash flow near prior year: Operating cash flow was $64.3 million for 2025 against $64.9 million; fourth quarter was $26.9 million against $24.4 million. Source
  • Cash and securities totaled $299.5M: Cash, cash equivalents and marketable investment securities totaled $299.5 million at December 31, 2025. Source
  • Cash fell while securities rose: Cash and equivalents were $116.7 million, down from $119.7 million; marketable securities were $182.8 million, up from $173.4 million. Source
  • Receivables fell, payables rose: Accounts receivable fell to $43.4 million from $51.2 million. Accounts payable rose to $18.7 million from $6.9 million. Source

Capital spending and acquisitions

  • Capital spending rose to $36.0M: Purchases of property and equipment were $36.0 million for 2025 against $28.3 million; net property and equipment rose to $97.4 million from $51.1 million. Source
  • Asset acquisition paid $18.7M: Net cash paid for an asset acquisition was $18.7 million in 2025, and a $2.1 million loan receivable was issued. Contingent consideration totaled $2.5 million at year-end. Source
  • Employee tax payments on RSUs rose: Payments of employees’ taxes on vested restricted stock units were $11.7 million in 2025, against $8.8 million. Source

Clinical evidence and product launches

  • AdvanceAD-Tx limited access launch: AdvanceAD-Tx was launched on limited access for atopic dermatitis. It is designed to identify patients with a JAKi responder profile, per a study published in JAAD. Source
  • Uveal melanoma genetics study published: A prospective study compared next-generation sequencing mutation analysis with DecisionDx-UM plus PRAME expression for predicting uveal melanoma outcomes. Source
  • Melanoma data shown at European congress: DecisionDx-Melanoma data on sentinel lymph node decisions and recurrence risk were presented in two oral talks. Source

People and corporate recognition

  • Named Houston Top Workplace: The Houston Chronicle recognized the company as a Houston Top Workplace, a ranking for people-focused workplace cultures. Source
  • Three culture awards earned: Three Culture Excellence awards covered employee appreciation, employee well-being and professional development. Source
  • Fifth consecutive year in ranking: The Houston Top Workplace recognition marked the fifth consecutive year the company had been ranked among the metro area’s workplaces. Source

Coming up, as management said on 26 February 2026

  • Core test adoption growth expected: Management expects continued test adoption growth for its core tests and a pipeline of further tests. Source

Figures management reported

FigureReported
Patient volumes (core test reports) Source+37% for 2025; +42% in the fourth quarter

Risks management discussed

  • Regulatory: The DecisionDx-SCC Medicare coverage change, effective April 24, 2025, reduced 2025 revenue and test report volume. Source
  • Financial: Fourth-quarter GAAP revenue included a $5.1 million net reduction from changes in estimates on prior-period test reports. Source

Earlier plans management reported on

  • Ahead: Management said full-year 2025 revenue exceeded guidance, with revenue of $344 million. Source
  • Not stated: Management said the AdvanceAD-Tx launch reinforced its commitment to providing clinical answers to dermatology clinicians. Source

Other quarters

Summarised with AI from the documents the company filed with the SEC. Every point is checked against the filing before it is shown: management’s own words word for word, figures against the line or table row they come from. A point that fails the check is left out. Source opens the filing at that line.