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Castle Biosciences Inc.: Q3 FY2026 earnings call

What management said about Q3 FY2026, from the documents filed with the SEC on 5 November 2026: press release. Guidance figures: 1 raised. The quarter’s numbers.

Key takeaways

  • Revenue rose 24% on the year: Third-quarter revenue was $102.9 million, against $83.0 million in the same quarter of 2025. Adjusted revenues, which exclude prior-period test report adjustments, were $101.9 million, against $80.5 million. Source
  • TissueCypher named key growth contributor: Management called TissueCypher a key contributor to top-line performance. Core revenue driver test reports, DecisionDx-Melanoma and TissueCypher combined, rose 22% against the prior-year quarter. Source
  • Adjusted EBITDA rose in the quarter: Nine-month Adjusted EBITDA was $20.0 million, down from $32.5 million a year earlier. Nine-month net loss was $20.7 million, against $21.8 million in the prior-year period. Source
  • Net loss widened on higher costs: Net loss was $4.1 million, or $0.13 per share, against a net loss of $0.5 million, or $0.02 per share, a year earlier. The quarter included $11.2 million of non-cash stock-based compensation. Source
  • Operating cash flow lower in quarter: Net cash from operations was $19.7 million in the quarter, against $22.6 million a year earlier. For nine months it was $12.8 million, against $37.4 million. Source
  • TissueCypher changed management decisions: A study published by the company found clinicians changed management recommendations after receiving TissueCypher results in 90% of cases, with de-escalation for 84% of low-risk patients. Source
  • Full-year revenue guidance raised: Management raised 2026 total revenue guidance to $385-395 million. The prior range of $365-375 million had been set in the second-quarter release. Source

“Overall, our third-quarter results reflect the strength of our portfolio, consistent execution and continued progress toward our long-term growth objectives.”

Derek Maetzold, president and chief executive officer of Castle Biosciences

Guidance

AreaPeriodFigureAgainst last quarter
Total revenue Sourcefull year 2026$385-395 millionRaised from $365-375 million

What changed from last quarter

  • Guidance raised: 2026 total revenue guidance raised to $385-395 million from $365-375 million. Source
  • New guidance: Positive Adjusted EBITDA expectation extended to full year 2027, which the prior release did not include. Source
  • New: Laboratory and office facility in Scottsdale, Arizona opened. Source
  • New: Additional SciBase order placed for the portable pen device and electrodes, valued at about $0.6 million. Source

Quarter results and growth drivers

  • Revenue rose 24% on the year: Third-quarter revenue was $102.9 million, against $83.0 million in the same quarter of 2025. Adjusted revenues, which exclude prior-period test report adjustments, were $101.9 million, against $80.5 million. Source
  • TissueCypher named key growth contributor: Management called TissueCypher a key contributor to top-line performance. Core revenue driver test reports, DecisionDx-Melanoma and TissueCypher combined, rose 22% against the prior-year quarter. Source
  • Nine-month revenue higher year on year: Nine-month revenue was $290.1 million, up from $257.2 million. Management said the prior-year comparison reflects the DecisionDx-SCC coverage change, a commercial refocus and the IDgenetix discontinuation. Source
  • Adjusted EBITDA rose in the quarter: Nine-month Adjusted EBITDA was $20.0 million, down from $32.5 million a year earlier. Nine-month net loss was $20.7 million, against $21.8 million in the prior-year period. Source

Dermatology and gastroenterology volumes

  • Dermatology team delivered 15,168 reports: Across DecisionDx-Melanoma, DecisionDx-SCC and AdvanceAD-Tx, the dermatology commercial team delivered 15,168 test reports in the quarter. Source
  • Melanoma volume up over nine months: DecisionDx-Melanoma test reports grew 5% over the first nine months, and management called the test the foundation of its dermatologic franchise. Quarterly melanoma reports were slightly below the prior year. Source
  • SCC and MyPath volumes fell: DecisionDx-SCC and MyPath Melanoma test reports were lower than in the third quarter of 2025, and DecisionDx-UM was slightly lower. AdvanceAD-Tx and Esopredict were not offered in the prior-year quarter. Source

“TissueCypher was a key contributor to our top-line performance, delivering 47% year-over-year growth in test report volume compared to the third quarter of 2025.”

Derek Maetzold, president and chief executive officer of Castle Biosciences

Margins and operating costs

  • Gross margins were flat year on year: Gross margin was 75% and Adjusted Gross Margin 77%, compared with 75% and 77% in the prior-year quarter. Table figures are 74.7% and 76.5%. Source
  • Net loss widened on higher costs: Net loss was $4.1 million, or $0.13 per share, against a net loss of $0.5 million, or $0.02 per share, a year earlier. The quarter included $11.2 million of non-cash stock-based compensation. Source
  • Selling and R&D spending increased: Selling, general and administrative expense was $63.8 million, against $55.9 million, and research and development was $15.8 million, against $13.0 million. Cost of sales was $23.9 million, up from $18.7 million. Source
  • Nine-month margin reflects prior-year charge: Nine-month gross margin was 74.2% against 66.8%, and Adjusted Gross Margin was 76.8% against 79.9%. Prior-year results included a one-time IDgenetix amortization acceleration of $20.1 million. Source
  • Prior-period revenue adjustments reduced revenue: Revenue from prior-period test reports reduced third-quarter revenue by $0.9 million, against a $2.5 million reduction a year earlier. Source

Cash, balance sheet and capital

  • Operating cash flow lower in quarter: Net cash from operations was $19.7 million in the quarter, against $22.6 million a year earlier. For nine months it was $12.8 million, against $37.4 million. Source
  • Cash and securities total $277.7 million: Cash, cash equivalents and marketable investment securities were $277.7 million at September 30, up from $266.8 million at June 30. Cash and equivalents alone were $78.0 million. Source
  • Property spending held steady: Purchases of property and equipment were $28.6 million for nine months, against $28.8 million a year earlier. Property and equipment, net, rose to $111.5 million at September 30. Source
  • Debt balances at September 30: Current portion of long-term debt was $4.2 million and long-term debt $5.9 million at September 30. Source

Clinical evidence and publications

  • TissueCypher changed management decisions: A study published by the company found clinicians changed management recommendations after receiving TissueCypher results in 90% of cases, with de-escalation for 84% of low-risk patients. Source
  • SLNB study supports melanoma decisions: Among 676 low-risk patients who had SLNB, observed positivity was 4.4%. Five-year recurrence-free survival was 99.6% in 565 low-risk patients who did not undergo SLNB. Source
  • Integrated SCC result validated in JAAD: A JAAD multi-center study validated the integrated DecisionDx-SCC result, which combines 40 genes with five clinicopathologic risk factors for prognosis and adjuvant radiation therapy decisions. Source
  • AdvanceAD-Tx atopic dermatitis publication: A new paper described difficulties atopic dermatitis patients have reaching treatment goals and interest in molecular testing. Management said it complements an earlier JAAD validation of AdvanceAD-Tx. Source
  • Barrett’s modeling study on management: A decision modeling study found simulated use of TissueCypher increased management aligned with progression outcomes for patients with NDBE, IND and LGD. Source

Pipeline, facility and partnership

  • Scottsdale laboratory and office opened: The company opened a 55,000-square-foot laboratory and office facility in Scottsdale, Arizona, adding space, infrastructure and capacity in the Phoenix area. Source
  • SciBase order for pen devices: Castle placed an additional order with SciBase for the portable pen device and electrodes, valued at about $0.6 million. Deliveries began early in the fourth quarter of 2026. Source

Revenue guidance and profit expectations

  • Full-year revenue guidance raised: Management raised 2026 total revenue guidance to $385-395 million. The prior range of $365-375 million had been set in the second-quarter release. Source
  • Positive Adjusted EBITDA expectation extended: Management kept its expectation of positive Adjusted EBITDA for the fourth quarter and full year 2026, and added full year 2027 to the expectation. Source

Coming up, as management said on 5 November 2026

  • Positive Adjusted EBITDA expected next: Management expects positive Adjusted EBITDA in the fourth quarter and full year 2026, and in full year 2027. Source
  • Second SciBase study in preparation: Preparations for a second clinical study under the SciBase collaboration are under way alongside the current study. Source
  • Scottsdale capacity for future growth: Management said the Scottsdale facility supports current work and anticipated growth in the future. Source

Figures management reported

FigureReported
TissueCypher Barrett’s Esophagus test reports, third quarter 2026 Source15,574 vs 10,609 in third quarter 2025
DecisionDx-Melanoma test reports, third quarter 2026 Source10,177 vs 10,459 in third quarter 2025
Core revenue driver test reports growth, third quarter 2026 Source+22%
DecisionDx-Melanoma test reports, nine months 2026 Source30,478 vs 29,061 for nine months 2025
TissueCypher Barrett’s Esophagus test reports, nine months 2026 Source42,307 vs 27,211 for nine months 2025
AdvanceAD-Tx test reports, third quarter 2026 Source1,109 (not offered in third quarter 2025)

Earlier plans management reported on

  • Not stated: Management said it maintains its expectation of positive Adjusted EBITDA, which was first given in the prior release for the third quarter, fourth quarter and full year 2026. Source
  • Not stated: The $385-395 million range replaces the previously provided $365-375 million range. 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.