Castle Biosciences, Inc. · NASDAQ:CSTL
Castle Biosciences — Q3 2026 Earnings Presentation
32 slides from Castle Biosciences's earnings presentation, Nov 5, 2026
Slide 1: Empowering people, informing care decisions
©2026 Castle Biosciences 1 Empowering people, informing care decisions November 2026
Slide 2: Disclaimers: Forward Looking Statements
©2026 Castle Biosciences 2 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 harb
Slide 3: Disclaimers: Financial Information; Non-GAAP Financial Measures
©2026 Castle Biosciences 3 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 accou
Slide 4: Registered Trademarks
©2026 Castle Biosciences 4 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.
Slide 5: Improving health through innovative tests that guide patient care
©2026 Castle Biosciences 5 Improving health through innovative tests that guide patient care OUR MISSION Transforming disease management by keeping people first: patients, clinicians, employees, and investors OUR VISION
Slide 6: Clinical differentiation, commercial execution, and financial discipline
©2026 Castle Biosciences 6 Clinical differentiation, commercial execution, and financial discipline Clinical differentiation 158 Peer-reviewed studies published across all franchises (as of 12/31/2025) Commercial adoption 32,431 Q3 2026 total test reports Financial execution $12.7M Q3 2026 Adjusted
Slide 7: Clinical portfolio and pipeline tests
©2026 Castle Biosciences 7 Clinical portfolio and pipeline tests Franchise Test Indication/Utility ~U.S. TAM1/Use Population Discovery Development Commercial Dermatology Cutaneous melanoma/ risk of sentinel lymph node positivity, recurrence & metastasis ~$540M/ 130k patients w/ invasive CM Cutaneous
Slide 8: DecisionDx-Melanoma
©2026 Castle Biosciences 8 DecisionDx-Melanoma DERMATOLOGY Provides comprehensive, personalized, genomic tumor information to guide management for patients with cutaneous melanoma demonstrated change in management for 1 of 2 patients tested3 ~263,000 patients with a clinical DecisionDx- Melanoma ord
Slide 9: DecisionDx-Melanoma risk and SEER outcomes data
©2026 Castle Biosciences 9 Individual risk of SLNB positivity Individual risk of recurrence ? 31-GEP Class Score Ulceration Breslow thickness Age Mitotic rate Ulceration Age Breslow thickness Mitotic rate SLN status Tumor location Collaborative study with the National Cancer Institute’s SEER Program
Slide 10: DECIDE Study was successful
10©2026 Castle Biosciences 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 Beard et al. Future Oncology 2026, Beard et al. SSO Annual Conference 2026. Pho
Slide 11: Prospective data confirm i31-SLNB improves SLNB decision-making
11©2026 Castle Biosciences 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
Slide 12: TissueCypher
©2026 Castle Biosciences 12 TissueCypher GASTROENTEROLOGY A leading risk-stratification test designed to predict risk of progression to esophageal cancer in patients with Barrett’s esophagus Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 17 peer-reviewed publicati
Slide 13: TissueCypher provides individualized 5-year risk of progression
©2026 Castle Biosciences 13 TissueCypher provides individualized 5-year risk of progression to HGD or EAC Low RiskHigh Risk • High Risk score enables increased surveillance or early intervention to prevent cancer1 • Low Risk score minimizes over-treatment and supports extension of surveillance inter
Slide 14: TissueCypher provides independent prediction of progression
©2026 Castle Biosciences 14 TissueCypher provides independent prediction of progression n=699 patients1-6, 150 incident progressors, 40 prevalent cases, 509 non-progressors No significant risk stratification 62% progressors detected 7.8x ↑ risk 2.7x ↑ risk 1. Critchley-Thorne RJ, et al. Cancer Epide
Slide 15: AdvanceAD-Tx
©2026 Castle Biosciences 15 AdvanceAD-Tx DERMATOLOGY 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-se
Slide 16: AdvanceAD-Tx guides systemic treatment choice in atopic dermatitis
16©2026 Castle Biosciences AdvanceAD-Tx results are intended to aid, not replace, clinical judgment. All treatment decisions should be made by the clinician in the context of the patient’s overall clinical picture. AdvanceAD-Tx guides systemic treatment choice for patients with moderate-to-severe at
Slide 17: AdvanceAD-Tx identifies patients with superior response to JAK inhibitors
17©2026 Castle Biosciences 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 Silverberg JI, Eichenfield LF, Armstrong AW, et al. The 487-gene expression profile test guides
Slide 18: AdvanceAD-Tx impacts clinical decision-making
18©2026 Castle Biosciences The AdvanceAD-Tx test meaningfully impacts clinical decision-making in guiding systemic treatment selection Ames et al. Revolutionizing Atopic Dermatitis (RAD) Conference 2026. The result distribution supports the heterogeneity of atopic dermatitis Th2 JAKi53.3%46.6% Perce
Slide 19: 97.8% of treatment decisions aligned with AdvanceAD-Tx result
19©2026 Castle Biosciences 97.8% of treatment decisions were aligned with AdvanceAD-Tx test result Ames et al. Revolutionizing Atopic Dermatitis (RAD) Conference 2026. Of patients were receiving treatment concordant with their molecular profile prior to testing POST TESTING DECISIONS THERAPEUTIC CLA
Slide 20: Financials
©2026 Castle Biosciences 20 Financials
Slide 21: Third Quarter 2026 Financial Highlights
©2026 Castle Biosciences 21 Third Quarter 2026 Financial Highlights Total Revenue Cash Position4 Adjusted EBITDA3 Total Report Volume Adjusted Gross Margin1,2 Net Loss $102.9M $277.7M$12.7M32,431 77% $(4.1)M 1. Adjusted Gross Margin is a non-GAAP measure. See Non-GAAP reconciliations at the end of t
Slide 22: Raising full-year revenue guidance on strong Q3 performance
©2026 Castle Biosciences 22 Raising full-year revenue guidance on strong Q3 performance Raised three times since February 2026, up $45 million at the midpoint $340-350M $345-355M $365-375M $385-395M $330M $340M $350M $360M $370M $380M $390M $400M Initial (Feb 2026) Q1 update (May 2026) Q2 update (Ju
Slide 23: Third Quarter 2026 Test Volume Results
©2026 Castle Biosciences 23 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 • Esopredic
Slide 24: Priorities supporting long-term value creation
©2026 Castle Biosciences 24 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 Allocate capital with discipline - Bala
Slide 25: Appendix
©2026 Castle Biosciences 25 Appendix
Slide 26: DecisionDx-SCC
©2026 Castle Biosciences 26 DecisionDx-SCC DERMATOLOGY Designed to provide risk assessment and treatment guidance for patients with high-risk SCC Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 24 peer-reviewed publications1, including data showing that DecisionDx-
Slide 27: DecisionDx-SCC i40-GEP risk classes and clinical utility
©2026 Castle Biosciences 27 40-GEP + PNI, poor differentiation, immunosuppression, tumor diameter and tumor location Test ordered Biopsy from a patient with high-risk cutaneous SCC i40-GEP Result (MFS on validation cohort) Clinical Utility Based on metastatic risk 0-5% Metastatic Risk • Safe to defe
Slide 28: MyPath Melanoma
©2026 Castle Biosciences 28 MyPath Melanoma DERMATOLOGY Aids in the diagnosis and management for patients with ambiguous melanocytic lesions Clinical Validity and Utility Demonstrated validity, utility and impact, backed by 20 peer-reviewed publications1 demonstrating the performance and utility of
Slide 29: DecisionDx-UM
©2026 Castle Biosciences 29 DecisionDx-UM OPHTHALMOLOGY The standard of care for evaluating metastatic risk in uveal melanoma Standard of Care • Utilized in approximately 80% of newly diagnosed patients • Included in NCCN guidelines and considered standard of care peer-reviewed publications ~8 in 10
Slide 30: Reconciliation of Non-GAAP Financial Measures: Adjusted Revenues and Gross Margin
©2026 Castle Biosciences 30 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 informat
Slide 31: Reconciliation of Non-GAAP Financial Measures: Adjusted EBITDA
©2026 Castle Biosciences 31 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
Slide 32: Thank You
©2026 Castle Biosciences 32 Thank You