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Castle Biosciences Inc.: Q1 FY2026 earnings call

What management said about Q1 FY2026, from the documents filed with the SEC on 6 May 2026: press release. Guidance figures: 1 raised. The quarter’s numbers.

Key takeaways

  • Revenue down from prior-year quarter: Revenue was $83.7 million compared with $88.0 million a year earlier. The company attributed part of the change to DecisionDx-SCC Medicare coverage, a commercial refocus and the IDgenetix discontinuation. Source
  • Core test reports rose 36%: Combined test reports for the two core revenue drivers, DecisionDx-Melanoma and TissueCypher, rose 36% year over year, the company said. Source
  • Non-dermatologic revenue increased year over year: Revenue for non-dermatologic tests was $42.6 million, compared with $25.0 million in the same period of 2025. Source
  • Gross margin rose on prior-year charge: Gross margin was 73% against 49%, and Adjusted Gross Margin was 76% against 81%. The prior-year period included a one-time item. Source
  • Net loss smaller than prior year: Net loss was $14.5 million against $25.8 million a year earlier, and included $9.8 million of non-cash stock-based compensation. Source
  • Operating cash use increased year over year: Net cash used in operations was $22.1 million, against $6.0 million a year earlier. Source
  • Annual payouts drove the cash use: The quarter included annual bonus and health care benefit payments totaling $28.8 million, which the company said are not expected to recur in the rest of 2026. Source

“The Castle Biosciences team delivered outstanding results to start 2026, delivering $83.7 million in revenue,”

Derek Maetzold, president and chief executive officer of Castle Biosciences

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue SourceFull year 2026$345-355 millionRaised from $340-350 million

What changed from last quarter

  • Guidance raised: 2026 total revenue guidance raised to $345-355 million from $340-350 million. Source

Results and growth drivers

  • Revenue down from prior-year quarter: Revenue was $83.7 million compared with $88.0 million a year earlier. The company attributed part of the change to DecisionDx-SCC Medicare coverage, a commercial refocus and the IDgenetix discontinuation. Source
  • Core test reports rose 36%: Combined test reports for the two core revenue drivers, DecisionDx-Melanoma and TissueCypher, rose 36% year over year, the company said. Source

Test volumes and product mix

  • TissueCypher reports rose 58%: TissueCypher Barrett's Esophagus reports reached 11,745, against 7,432 a year earlier. The CEO's remarks cited 58% growth for this test. Source
  • DecisionDx-Melanoma reports up 16%: DecisionDx-Melanoma reports reached 10,021, against 8,621 a year earlier. The CEO's remarks cited 16% growth for this test. Source
  • Non-dermatologic revenue increased year over year: Revenue for non-dermatologic tests was $42.6 million, compared with $25.0 million in the same period of 2025. Source
  • DecisionDx-SCC reports declined: DecisionDx-SCC reports were 3,702, against 4,375 a year earlier. Revenue was affected by the April 2025 Medicare coverage change and the commercial refocus. Source
  • Smaller tests rose modestly: MyPath Melanoma reports were 973, against 926, and DecisionDx-UM reports were 492, against 470, a year earlier. Source

“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.”

Derek Maetzold, president and chief executive officer of Castle Biosciences

Costs, margins and pricing

  • Gross margin rose on prior-year charge: Gross margin was 73% against 49%, and Adjusted Gross Margin was 76% against 81%. The prior-year period included a one-time item. Source
  • One-time 2025 amortization charge: The prior-year quarter carried a one-time amortization acceleration of about $20.1 million, which the company said affected that quarter's gross margin. Source
  • Operating expense lines rose: Cost of sales was $20.5 million, research and development $14.4 million and selling, general and administrative $64.9 million, each above the prior-year quarter. Source
  • Operating loss smaller than prior year: Operating loss was $18.4 million against $27.9 million. Amortization of acquired intangible assets was $2.2 million, down from $28.3 million. Source

Net loss and per-share results

  • Net loss smaller than prior year: Net loss was $14.5 million against $25.8 million a year earlier, and included $9.8 million of non-cash stock-based compensation. Source
  • Loss per share of $0.49: Basic and diluted loss per share was $0.49, against $0.90 a year earlier. The prior-year quarter is also shown on an adjusted basis at $0.20. Source
  • Adjusted EBITDA turned to a loss: Adjusted EBITDA was $(5.1) million, against $13.0 million in the first quarter of 2025. Source

“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”

Derek Maetzold, president and chief executive officer of Castle Biosciences

Cash flow and bonus payments

  • Operating cash use increased year over year: Net cash used in operations was $22.1 million, against $6.0 million a year earlier. Source
  • Annual payouts drove the cash use: The quarter included annual bonus and health care benefit payments totaling $28.8 million, which the company said are not expected to recur in the rest of 2026. Source
  • Accrued compensation fell after payouts: Accrued compensation was $19.1 million at March 31, 2026, against $38.3 million at December 31, 2025. Source

Capital and share-related payments

  • Liquidity balance fell from year-end: Cash, cash equivalents and marketable investment securities totaled $261.7 million at March 31, 2026, against $299.5 million at December 31, 2025. Source
  • Property and equipment spending rose: Purchases of property and equipment were $12.5 million, against $4.7 million in the first quarter of 2025. Source
  • Employee tax payments on share awards: Payments of employees’ taxes on vested restricted stock units and performance-based units were $6.6 million, against $2.5 million a year earlier. Source
  • Weighted share count rose: Weighted-average basic and diluted shares were 29.9 million, up from 28.6 million a year earlier. Source

Clinical evidence and publications

  • Sentinel node study data released: New data from a prospective U.S. study reported a 2.6% positivity rate among patients with under 5% predicted sentinel lymph node risk. Source
  • Mayo data on TissueCypher surveillance: Mayo Clinic researchers reported that TissueCypher influenced surveillance intervals in more than half of patients at Digestive Disease Week. Source
  • Mortality data within AJCC stages: Data presented at the American Academy of Dermatology meeting described DecisionDx-Melanoma differences in mortality risk within the same AJCC stage. Source
  • AdvanceAD-Tx publication in JAAD: A JAAD publication described AdvanceAD-Tx identifying patients more likely to respond faster to a Janus kinase inhibitor than to Th2-targeted therapy. Source

Reporting and non-GAAP measures

  • Adjusted Revenues shown alongside GAAP: Adjusted Revenues, which exclude revenue tied to prior-period test reports, were $84.2 million against $87.2 million. Prior-period adjustments added $551 thousand this quarter. Source
  • Adjusted loss per share equals GAAP: Adjusted net loss per share was $(0.49), the same as the GAAP figure, because no one-time amortization adjustment applied to the first quarter of 2026. Source

Coming up, as management said on 6 May 2026

  • Results call on May 6: Management will hold the first-quarter results call and corporate update on May 6, 2026 at 4:30 p.m. Eastern. Source
  • Skin Cancer Awareness Month programs: The company is supporting May initiatives including advocacy walks, community screenings and patient education with advocacy organizations. Source

Figures management reported

FigureReported
Patient volumes SourceCore test reports up 36%: DecisionDx-Melanoma 10,021 vs 8,621; TissueCypher 11,745 vs 7,432

Risks management discussed

  • Regulatory: The DecisionDx-SCC Medicare coverage change effective April 24, 2025 affected first quarter 2026 revenue, along with the commercial refocus and IDgenetix discontinuation. Source
  • Demand: DecisionDx-SCC reports fell to 3,702 from 4,375 in the prior-year quarter, a decline in reported test volume for this test. 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.