Castle Biosciences, Inc. · NASDAQ:CSTL
Castle Biosciences — Q3 2026 Earnings Presentation
32 slides from Castle Biosciences's earnings presentation, November 2026
Slide 1: Empowering people, informing care decisions
Empowering people, informing care decisions November 2026 ©2026 Castle Biosciences 1
Slide 2: Disclaimers: Forward Looking Statements
Disclaimers Forward Looking Statements This presentation contains forward-looking statements within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended, which are subject to the “safe harbor” created by those sectio
Slide 3: Disclaimers: Non-GAAP Financial Measures
Disclaimers Financial Information; Non-GAAP Financial Measures In this presentation, we use the metrics of Adjusted Revenues, Adjusted Gross Margin and Adjusted EBITDA, which are non-GAAP financial measures and are not calculated in accordance with generally accepted accounting principles in the Uni
Slide 4: Registered Trademarks
Registered Trademarks DecisionDx-Melanoma, DecisionDx-CMSeq, i31-SLNB, i31-ROR, DecisionDx-SCC, MyPath Melanoma, AdvanceAD-Tx, TissueCypher, Esopredict, DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq are trademarks of Castle Biosciences, Inc. ©2026 Castle Biosciences 4
Slide 5: Improving health through innovative tests that guide patient care
OUR MISSION Improving health through innovative tests that guide patient care OUR VISION Transforming disease management by keeping people first: patients, clinicians, employees, and investors ©2026 Castle Biosciences 5
Slide 6: Clinical differentiation, commercial execution, and financial discipline
Clinical differentiation, commercial execution, and financial discipline Clinical Commercial differentiation adoption Financial execution Capital strength 158 32,431 $12.7M $278M Peer-reviewed studies Q3 2026 total test Q3 2026 Adjusted Cash and marketable published across all reports EBITDA1 securi
Slide 7: Clinical portfolio and pipeline tests
Clinical portfolio and pipeline tests ~U.S. TAM1/Use Franchise Test Indication/Utility Discovery Development Commercial Population Cutaneous melanoma/ ~$540M/ risk of sentinel lymph node positivity, 130k patients w/ recurrence & metastasis invasive CM Cutaneous squamous cell carcinoma/ ~$820M/ risk
Slide 8: DecisionDx-Melanoma
DERMATOLOGY DecisionDx-Melanoma Provides comprehensive, personalized, genomic tumor information to guide management for patients with cutaneous melanoma Clinical Validity, Utility and SLNB Guidance and Patient Demonstrated Patient Outcomes2 Outcomes New data from Castle’s Demonstrated clinical ongoi
Slide 9: DecisionDx-Melanoma provides precise, personalized risk prediction
DecisionDx-Melanoma provides precise, personalized risk prediction for two critical clinical questions Collaborative study with the National Cancer Institute’s SEER Program Registries is the largest real- Clinical use of DecisionDx-Melanoma is associated with improved patient survival world study of
Slide 10: DECIDE Study was successful
DECIDE Study was successful Patients predicted to have <5% SLN positivity had a 2.6% actual rate DECIDE Study was successful Patients predicted to have <5% SLN positivity had a 2.6% actual rate SLN positivity rates by i31-SLNB result Fold Difference <5% 5-10% >10% <5% vs. >10% Patients with >10% pre
Slide 11: Prospective data confirm i31-SLNB improves SLNB decision-making
Prospective data confirm that DecisionDx-Melanoma i31-SLNB result improves SLNB decision-making and supports favorable patient outcomes Prospective data confirm that DecisionDx- Melanoma i31-SLNB result improves SLNB decision- making and supports favorable patient outcomes 1 2 3 Accurate risk Confid
Slide 12: TissueCypher
GASTROENTEROLOGY TissueCypher A leading risk-stratification test designed to predict risk of progression to esophageal cancer in patients with Barrett’s esophagus Clinical Validity and Utility Recognition from AGA Demonstrated validity, utility 2024 Clinical Practice Guideline and impact, backed by
Slide 13: TissueCypher provides individualized 5-year risk of progression
TissueCypher provides individualized 5-year risk of progression to HGD or EAC Indicated for NDBE, IND, and LGD • High Risk score enables increased surveillance or early intervention to prevent cancer1 • Low Risk score minimizes over-treatment and supports extension of surveillance intervals to guide
Slide 14: TissueCypher provides independent prediction of progression
TissueCypher provides independent prediction of progression Real world histologic grading TissueCypher risk class 7.8x ↑ risk 2.7x ↑ risk No significant risk stratification 62% progressors detected n=699 patients1-6, 150 incident progressors, 40 prevalent cases, 509 non-progressors 1. Critchley-Thor
Slide 15: AdvanceAD-Tx
DERMATOLOGY AdvanceAD-Tx A non-invasive molecular test that is designed to detect the underlying immune biology of atopic dermatitis (AD) that is driving an individual patient’s AD and thus helps to guide systemic treatment decision making in patients with moderate- to-severe AD Validated in Real-Wo
Slide 16: AdvanceAD-Tx guides systemic treatment choice for atopic dermatitis
AdvanceAD-Tx guides systemic treatment choice for patients with moderate-to-severe atopic dermatitis AdvanceAD-Tx guides systemic treatment choice for patients with moderate-to-severe atopic dermatitis JAK Inhibitor Responder Profile Gene expression profile is associated Moderate-to- with a signific
Slide 17: AdvanceAD-Tx identifies patients with superior response to JAK inhibitors
AdvanceAD-Tx identifies patients who have a superior response to JAK inhibitor therapies AdvanceAD-Tx identifies patients who have a superior response to JAK inhibitor therapies Patients with JAK Inhibitor Responder Profile who are treated with a JAK inhibitor therapy, compared to those treated with
Slide 18: AdvanceAD-Tx impacts clinical decision-making in systemic treatment selection
The AdvanceAD-Tx test meaningfully impacts clinical decision-making in guiding systemic treatment selection • An independent, multi-center case series evaluated the clinical utility The result distribution The test was ordered across of the test in guiding initial or supports the treatment lines sub
Slide 19: 97.8% of treatment decisions aligned with AdvanceAD-Tx result
97.8% of treatment decisions were aligned with AdvanceAD-Tx test result POST TESTING DECISIONS THERAPEUTIC CLASS SWITCHING TREATMENT DISTRIBUTION After testing, therapeutic class switching Overall, post-testing treatment occurred in 71.4% of patients distribution shifted to 51% 20% 21 14 of patients
Slide 20: Financials
Financials ©2026 Castle Biosciences 20
Slide 21: Third Quarter 2026 Financial Highlights
Third Quarter 2026 Financial Highlights Track record of consistent execution and strong business fundamentals Adjusted Total Total Report Net Adjusted Cash Gross Revenue Volume Loss EBITDA3 Position4 Margin1,2 3Q26 $102.9M 32,431 77% $(4.1)M $12.7M $277.7M 1. Adjusted Gross Margin is a non-GAAP meas
Slide 22: Raising full-year revenue guidance on strong Q3 performance
Raising full-year revenue guidance on strong Q3 performance Raised three times since February 2026, up $45 million at the midpoint Guidance midpoint, $M (guided range labeled) $400M $390M $385-395M $380M $365-375M $370M $360M $350M $345-355M $340M $340-350M $330M Initial (Feb 2026) Q1 update (May 20
Slide 23: Third Quarter 2026 Test Volume Results
Third Quarter 2026 Test Volume Results 3Q26 3Q25 Core Revenue Drivers: • DecisionDx-Melanoma 10,177 10,459 • TissueCypher 15,574 10,609 Additional Tests: • DecisionDx-SCC1 3,882 4,186 • MyPath Melanoma 798 1,151 • DecisionDx-UM 422 436 • AdvanceAD-Tx 1,109 N/A • Esopredict 469 N/A TissueCypher test
Slide 24: Priorities supporting long-term value creation
Priorities supporting long-term value creation Expand test adoption - Deepen clinician utilization and sustain commercial momentum Advance evidence - Strengthen clinical utility evidence and pursue appropriate reimbursement coverage Scale efficiently - Maintain focus on gross margin, operating expen
Slide 25: Appendix
Appendix ©2026 Castle Biosciences 25
Slide 26: DecisionDx-SCC
DERMATOLOGY DecisionDx-SCC Designed to provide risk assessment and treatment guidance for patients with high-risk SCC Clinical Validity and Utility Real-World Use Framework Demonstrated validity, Several published studies in utility and impact, backed by 24 peer-reviewed 2024 supported the use of De
Slide 27: DecisionDx-SCC informs patient management decisions
DecisionDx-SCC informs patient management decisions i40-GEP Result Clinical Utility (MFS on validation cohort) Based on metastatic risk The overall validation cohort MFS is 88.8% Class 1A 0-5% Metastatic Risk Clinicians consider the following management Low Risk • Safe to defer imaging for patients
Slide 28: MyPath Melanoma
DERMATOLOGY MyPath Melanoma Aids in the diagnosis and management for patients with ambiguous melanocytic lesions Clinical Validity and Utility Guideline Support Demonstrated validity, • National Comprehensive utility and impact, backed Cancer Network guidelines by 20 peer-reviewed for cutaneous mela
Slide 29: DecisionDx-UM
OPHTHALMOLOGY DecisionDx-UM The standard of care for evaluating metastatic risk in uveal melanoma Clinical Validity and Utility Standard of Care Demonstrated validity, • Utilized in approximately utility and impact, backed 80% of newly diagnosed by 39 peer-reviewed patients publications, which • Inc
Slide 30: Reconciliation of Non-GAAP Financial Measures (Unaudited)
Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of Adjusted Revenues and Adjusted Gross Margin, which are non-GAAP financial measures. See “Financial information; Non-GAAP Financial Measures" above for further information regarding the Company's
Slide 31: Reconciliation of Non-GAAP Financial Measures (Unaudited)
Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of Adjusted EBITDA, which is a non-GAAP financial measure. See “Financial information; Non-GAAP Financial Measures" above for further information regarding the Company's use of non-GAAP financial me
Slide 32: Thank You
Thank You ©2026 Castle Biosciences 32