Financial Data and Key Metrics Changes - Castle Biosciences reported fourth quarter revenue of $87 million, leading to a total revenue of $344.2 million for the full year 2025, exceeding guidance [6][21] - Excluding DecisionDx-SCC and IDgenetix revenue, the revenue growth for 2025 would have been approximately 34% [7] - The adjusted gross margin for the fourth quarter was 76.3%, compared to 76.2% in the fourth quarter of 2024, while the full year gross margin was 69.2%, down from 78.5% in 2024 [22][24] - The net loss for the fourth quarter was $2.3 million, compared to net income of $9.6 million for the same period in 2024, and the full year net loss was $24.2 million, compared to net income of $18.2 million in 2024 [27] Business Line Data and Key Metrics Changes - Total test report volume for the year was 105,053, a 37% increase compared to 2024, with TissueCypher report volume growing by 86% [8][10] - DecisionDx-Melanoma delivered 39,083 test reports in 2025, representing 9% year-over-year growth, while TissueCypher delivered 39,014 test reports [10][11] - The number of new ordering clinicians for TissueCypher increased to 2,082 in 2025, up from 1,234 in 2024 [13] Market Data and Key Metrics Changes - The company noted a patient penetration of approximately 31% for DecisionDx-Melanoma and 11% for TissueCypher exiting 2025 [11][13] - The American Gastroenterological Association recognized TissueCypher as a significant prognostic test for Barrett's esophagus, which is crucial for identifying high-risk patients [12][13] Company Strategy and Development Direction - Castle Biosciences aims to drive growth through its core revenue drivers, DecisionDx-Melanoma and TissueCypher, while also expanding into dermatology with the AdvanceAD-Tx test [9][15] - The company plans to initiate a pipeline test for GI diseases and evaluate EIS technology in collaboration with SciBase [17][18] - M&A will continue to play a role in the company's growth strategy, focusing on tests that are near or at market and reimbursement [19] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's growth story, emphasizing disciplined execution and the strength of the balance sheet [9][20] - For 2026, the company anticipates total revenue of $340 million to $350 million, reflecting mid to high teens growth over 2025 [21] - Management highlighted the importance of FDA clearance for DecisionDx-Melanoma to enhance reimbursement discussions and adoption [43] Other Important Information - The company completed the acquisition of Previse and launched the AdvanceAD-Tx test, which is expected to contribute materially to revenue in 2027 or 2028 [8][15] - Total operating expenses for 2025 were $387 million, up from $323.4 million in 2024, driven by increased personnel costs and higher sales and marketing expenses [25][26] Q&A Session Summary Question: Update on NCCN guidelines for DecisionDx-Melanoma - Management noted that the current guidelines did not change the threshold for sentinel lymph node biopsy and highlighted the importance of their test in reducing unnecessary procedures [35][36] Question: Timeline for FDA approval of DecisionDx-Melanoma - The company is preparing a de novo 510(k) submission, with expectations for acceptance by the end of the year or early next year, which could impact clinician adoption [42][43] Question: Strategy for AdvanceAD-Tx test - The sales team is focusing on maintaining momentum for DecisionDx-Melanoma while gradually introducing AdvanceAD-Tx, with plans to shift sales focus as adoption increases [49][50] Question: Expectations for TissueCypher volume growth - Management expects continued volume growth for TissueCypher, driven by both existing ordering clinicians and new clinician adoption, although growth rates may moderate as penetration increases [75] Question: Impact of potential LCD for DecisionDx-SCC - Management indicated that if an LCD is published, they would fold DecisionDx-SCC back into the sales strategy, but timing and confidence in reimbursement will dictate the approach [81][82]

Financial Data and Key Metrics Changes - In Q4 2025, the company reported total revenue of $87 million, leading to a full-year revenue of $344.2 million, exceeding guidance [21][30] - Excluding DecisionDx-SCC and IDgenetix revenue, the revenue growth for 2025 would have been approximately 34% [7] - The adjusted gross margin for Q4 was 76.3%, slightly up from 76.2% in Q4 2024, while the full-year gross margin was 69.2%, down from 78.5% in 2024 [22][24] - The net loss for Q4 2025 was $2.3 million, compared to a net income of $9.6 million in Q4 2024, and the full-year net loss was $24.2 million, compared to a net income of $18.2 million in 2024 [27] Business Line Data and Key Metrics Changes - The total test report volume for 2025 was 105,053, a 37% increase compared to 2024, with TissueCypher report volume growing by 86% [8][11] - DecisionDx-Melanoma delivered 39,083 test reports in 2025, reflecting a 9% year-over-year growth, while TissueCypher achieved 39,014 test reports [10][11] - The company had 2,082 new ordering clinicians for TissueCypher in 2025, up from 1,234 in 2024 [13] Market Data and Key Metrics Changes - The company reported approximately 31% patient penetration for DecisionDx-Melanoma and 11% for TissueCypher exiting 2025 [11][13] - The company is focusing on expanding its addressable market through the launch of AdvanceAD-Tx, which targets patients with moderate to severe atopic dermatitis [15] Company Strategy and Development Direction - The company aims to drive growth through its core revenue drivers, DecisionDx-Melanoma and TissueCypher, while also expanding into dermatology with AdvanceAD-Tx [10][15] - The company plans to continue evaluating M&A opportunities that align with its strategic criteria, focusing on tests that are near or at market and reimbursement [19] - The long-term growth strategy includes developing a pipeline test for GI diseases and collaborating with SciBase for EIS technology [17][18] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's growth trajectory, emphasizing the importance of disciplined execution and innovation [6][31] - The anticipated revenue for 2026 is projected to be between $340 million and $350 million, reflecting mid to high teens growth over 2025 [21] - Management acknowledged the challenges posed by the operating environment but remains focused on improving patient care through innovative tests [9] Other Important Information - The company completed the acquisition of Previse and launched the AdvanceAD-Tx test in late 2025, which is expected to contribute materially to revenue in 2027 or 2028 [8][15] - The company had cash equivalents and marketable securities of $299.5 million as of December 31, 2025 [29] Q&A Session Summary Question: Update on DecisionDx-Melanoma and NCCN guidelines - Management noted that the NCCN guidelines did not change the threshold for sentinel lymph node biopsy, and while DecisionDx-Melanoma data supports its use, only a fraction of studies were included in the guidelines [34][36][38] Question: FDA submission timeline for DecisionDx-Melanoma - The company is preparing a de novo 510(k) submission, expecting acceptance by the end of 2026 or early 2027, which could enhance reimbursement discussions [41][43] Question: Strategy for AdvanceAD-Tx and sales team approach - The sales team is currently focused on DecisionDx-Melanoma, with plans to gradually incorporate AdvanceAD-Tx as awareness and adoption grow [47][50] Question: TissueCypher sales team and growth strategy - The company continues to expand the TissueCypher sales team and is exploring opportunities with larger group practices to enhance efficiency and volume [53][56] Question: Expectations for TissueCypher volume growth in 2026 - Management anticipates continued volume growth for TissueCypher, driven by both existing and new clinicians, although growth rates may moderate as penetration increases [71][75]

Financial Data and Key Metrics Changes - In Q4 2025, Castle Biosciences reported total revenue of $87 million, leading to a full-year revenue of $344.2 million, exceeding guidance [5][19] - Full-year revenue growth, excluding DecisionDx-SCC and IDgenetix, was approximately 34% [5] - Adjusted EBITDA for Q4 was $11.5 million, down from $21.3 million in Q4 2024, and for the full year, it was $44 million compared to $75 million in 2024 [25][26] Business Line Data and Key Metrics Changes - DecisionDx-Melanoma generated 39,083 test reports in 2025, reflecting a 9% year-over-year growth [9] - TissueCypher achieved 39,014 test reports in 2025, representing an 86% increase from 2024 [10] - Total test report volume for the year was 105,053, a 37% increase compared to 2024 [6] Market Data and Key Metrics Changes - The company noted a patient penetration of approximately 31% for DecisionDx-Melanoma and 11% for TissueCypher by the end of 2025 [10][12] - The dermatology market is expected to expand significantly with the launch of the AdvanceAD-Tx test, which is anticipated to contribute materially to revenue in 2027 or 2028 [14] Company Strategy and Development Direction - Castle Biosciences aims to enhance patient care through innovative tests and has outlined a growth strategy that includes near-term, mid-term, and long-term initiatives [8][15] - The company plans to continue evaluating M&A opportunities that align with its strategic goals, focusing on tests that are near or at market and reimbursement [17] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the growth potential of DecisionDx-Melanoma and TissueCypher, citing strong clinician adoption and ongoing clinical evidence [10][12] - The company anticipates total revenue for 2026 to be between $340 million and $350 million, reflecting mid to high teens growth over 2025 [19] Other Important Information - The gross margin for Q4 2025 was 76.3%, slightly up from 76.2% in Q4 2024, while the full-year gross margin was 69.2%, down from 78.5% in 2024 [20] - The company had cash equivalents and marketable securities of $299.5 million as of December 31, 2025 [27] Q&A Session Summary Question: Update on DecisionDx-Melanoma and NCCN guidelines - Management highlighted that the NCCN guidelines did not change the threshold for sentinel lymph node biopsy, maintaining a 5% standard, and noted the importance of their test in potentially avoiding unnecessary procedures [32][33] Question: FDA submission timeline for DecisionDx-Melanoma - The company is preparing a de novo 510(k) submission, expecting acceptance by the end of 2026 or early 2027, which could enhance adoption and reimbursement discussions [38][39] Question: Strategy for AdvanceAD-Tx test - The sales team is focusing on maintaining momentum with DecisionDx-Melanoma while gradually introducing AdvanceAD-Tx, with a planned shift in sales focus as adoption increases [45][48] Question: TissueCypher sales team and growth - The company continues to expand the TissueCypher sales team and anticipates further growth through both existing and new clinician adoption [52][56] Question: Expectations for melanoma volume growth in 2026 - Management expects mid to high single-digit volume growth for melanoma tests in 2026, supported by strong clinician engagement [64][65]

Empowering people, informing care decisions February 2026 ©2026 Castle Biosciences 1 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 sections. These forward-looking statements include, but are not limited to, statements concerning: our positioning for continued grow ...

Core Insights - Castle Biosciences reported a strong performance in 2025, with total revenue reaching $344 million, exceeding guidance and reflecting a 4% increase from 2024 [5][9] - The company achieved a 37% increase in total test reports for its core revenue drivers, DecisionDx-Melanoma and TissueCypher, compared to 2024 [5][11] - The launch of AdvanceAD-Tx expanded the company's addressable market and demonstrated its commitment to providing clinical answers in dermatology [3][14] Financial Highlights - Revenues for 2025 were $344.2 million, up from $332.1 million in 2024, marking a 4% growth. Excluding certain discontinued tests, revenue growth was 34% [5][11] - Non-dermatologic test revenues increased significantly to $127.9 million from $75.1 million in 2024 [5] - The gross margin for 2025 was 69%, with an adjusted gross margin of 80%, compared to 79% and 82% in 2024 [5][11] Operational Performance - Total test reports for DecisionDx-Melanoma in 2025 were 39,083, up from 36,008 in 2024, while TissueCypher reports rose to 39,014 from 20,956 [5][11] - The company reported a net loss of $24.2 million for 2025, which included non-cash stock-based compensation of $45.9 million, compared to a net income of $18.2 million in 2024 [5][11] - Adjusted EBITDA for 2025 was $44 million, down from $75 million in 2024 [11][43] Market Position and Future Outlook - Castle Biosciences anticipates generating between $340 million and $350 million in total revenue for 2026, indicating stable growth expectations [9][26] - The company is well-positioned to capitalize on growth opportunities supported by continued test adoption and a robust pipeline [3][9] - The limited access launch of AdvanceAD-Tx is expected to enhance treatment decision-making for patients with moderate-to-severe atopic dermatitis [3][14]

Core Insights - Castle Biosciences, Inc. expects total revenue for 2025 to exceed $340 million, surpassing the previously guided range of $327-335 million [1] - The company reported a 37% increase in total test reports for core revenue drivers (DecisionDx-Melanoma, TissueCypher) in 2025 compared to 2024 [5] - Year-end 2025 cash, cash equivalents, and marketable investment securities are projected to be approximately $300 million [1] Financial Performance - Preliminary results for the fourth quarter of 2025 indicate a 42% increase in total test reports for core revenue drivers compared to Q4 2024 [4] - DecisionDx-Melanoma test reports delivered in Q4 2025 were 10,022, up from 8,672 in Q4 2024 [4] - TissueCypher Barrett's Esophagus test reports delivered in Q4 2025 were 11,803, compared to 6,672 in Q4 2024 [4] Product Launch and Market Expansion - The company launched AdvanceAD-Tx on a limited access basis in November 2025, with over 50% of the 150 clinician offices that were granted access ordering the test within the first five weeks [4] - The launch of AdvanceAD-Tx is expected to materially expand Castle's total addressable market [3] Test Report Trends - In 2025, DecisionDx-Melanoma test reports totaled 39,083, an increase from 36,008 in 2024 [5] - TissueCypher Barrett's Esophagus test reports in 2025 were 39,014, significantly up from 20,956 in 2024 [6] - DecisionDx-SCC test reports delivered in 2025 were 17,294, compared to 16,348 in 2024 [12] Cash Position - As of year-end 2025, the company expects to have approximately $116 million in cash and cash equivalents, along with about $184 million in marketable investment securities [7]

Summary of Castle Biosciences FY Conference Call Company Overview - Castle Biosciences is a molecular diagnostics company focused on proprietary algorithm-driven tests aimed at improving patient management and outcomes [2][3] Industry and Market Insights - The company operates primarily in the dermatology and gastroenterology sectors, with tests designed for conditions such as melanoma, atopic dermatitis, and Barrett's esophagus [5][7] - The total addressable market (TAM) for their tests is significant, with estimates of $540 million for melanoma tests, $820 million for high-risk cutaneous squamous cell carcinoma, and $1 billion for Barrett's esophagus [9][10][11] Financial Performance - In Q3 2025, Castle Biosciences reported a revenue growth of 36% year-over-year, matching the volume growth [2] - Adjusted gross margins decreased to 77% from 82% due to the loss of coverage for squamous cell carcinoma tests [3] - The company ended the quarter with cash and cash equivalents of $287 million, indicating a strong balance sheet [3] Product Developments - The company launched a new test called Advance ADTX for guiding systemic therapy selection in patients with moderate to severe atopic dermatitis [4] - The DecisionDx-SCC test demonstrated the ability to predict the likelihood of response to adjuvant radiation therapy in high-risk cutaneous squamous cell carcinoma patients [6] - Ongoing collaboration with SciBase aims to predict flares in atopic dermatitis patients using electrical impedance spectroscopy technology [7] Clinical Study Findings - A large prospective observational study validated a 487 gene expression profile test for atopic dermatitis, identifying two key profiles: TH2 molecular profile and JAK inhibitor responder profile [12][19] - Patients with a JAK inhibitor responder profile had a 45% chance of achieving EASI-90 (90% clearance) when treated with JAK inhibitors, compared to only 8.3% with TH2 biologic therapy [19] Market Research and Adoption - Approximately 78% of clinicians surveyed indicated they would likely use the new atopic dermatitis test after a brief overview [20] - The target population for the atopic dermatitis test is around 13 million patients aged 12 and older in the U.S. [10][22] Conclusion - Castle Biosciences is positioned for growth with a strong product pipeline and significant market opportunities in dermatology and gastroenterology, supported by promising clinical data and positive clinician feedback [23]

Castle Biosciences FY Conference Summary Company Overview - **Company**: Castle Biosciences (NasdaqGM:CSTL) - **Date**: November 19, 2025 - **Key Speaker**: Derek Maetzold, CEO Key Points Financial Performance - **Q3 Revenue Growth**: Normalized pro forma revenue grew by 36% year-over-year, matching the test volume growth of 36% for core TissueCypher and melanoma tests [4][5] - **Cash Position**: Ended the quarter with approximately $289 million in cash or cash equivalents, indicating a strong balance sheet [5] - **Year-End Guidance**: Raised guidance by $16 million, now projected between $327 million and $335 million [5] Product Performance - **DecisionDx-Melanoma**: Growth reaccelerated by 12% in Q3, attributed to a sales team refocus towards melanoma tests [6] - **Clinician Engagement**: 1,816 clinicians ordered DecisionDx-Melanoma tests in Q3, indicating strong market penetration [6] - **Market Penetration**: Estimated at around 30%, with ongoing efforts to drive adoption among clinicians [8] Clinical Studies and Data - **Influential Studies**: Key studies published have shown that patients who avoided sentinel lymph node biopsy based on low-risk results from DecisionDx-Melanoma had zero recurrences, supporting the test's clinical utility [11][12] - **Histological Subtyping**: Data presented at the Fall Clinical Dermatology meeting indicated that patients with low-risk results from the test had a 98.5% chance of being alive at five years [14] Regulatory and Reimbursement Insights - **FDA Breakthrough Designation**: Received earlier in the year, with plans for submission in early 2026 [16] - **Reimbursement Potential**: Anticipated improvements in coverage eligibility under state biomarker laws post-FDA approval [17][18] Market Dynamics - **Atopic Dermatitis Test Launch**: Targeting approximately 13 million patients with moderate to severe atopic dermatitis, aiming to identify JAK inhibitor responders [46][47] - **Market Research Feedback**: Positive responses from dermatologists regarding the test's ability to reduce trial and error in treatment [52] Growth Opportunities - **TissueCypher Expansion**: Plans to enhance the test with multi-omics capabilities and a non-endoscopic self-collection device [31][33] - **Sales Team Expansion**: Increased reach in the GI market, with a focus on improving touchpoints and frequency within existing areas [30] Financial Outlook - **Gross Margin Projections**: Expected to be in the mid-70% range on an adjusted basis, with potential pressure from the atopic dermatitis launch [56] - **Operating Leverage**: Anticipated growth in revenue and profitability as the company continues to expand its product offerings [58] Strategic Initiatives - **Capital Allocation**: Plans to invest in commercial activities, clinical studies, and pipeline opportunities, including collaborations with other companies [62] Misunderstood Elements - **Market Perception**: The focus on squamous cell carcinoma coverage overshadowed the healthy growth of the overall business, particularly in the TissueCypher segment [67] Conclusion Castle Biosciences is positioned for continued growth with strong financial performance, innovative product offerings, and strategic regulatory initiatives. The company is actively working to expand its market presence and improve patient outcomes through its diagnostic tests.

Financial Data and Key Metrics Changes - Revenue for Q3 2025 reached $83 million, with a total revenue guidance for 2025 raised to $327-$335 million from the previous range of $310-$320 million [18][19] - Gross margin for Q3 2025 was 74.7%, down from 79.2% in Q3 2024, while adjusted gross margin was 76.8% compared to 81.9% in the same period last year [19] - Net loss for Q3 2025 was $0.5 million, compared to net income of $2.3 million in Q3 2024, with diluted loss per share at $0.02 versus diluted earnings per share of $0.08 in the prior year [21] Business Line Data and Key Metrics Changes - Total test report volume for Q3 2025 was 26,841, with core revenue drivers growing 36% year-over-year [12] - DecisionDx-Melanoma reports reached 10,459, marking a 12% year-over-year increase and surpassing 10,000 reports in a single quarter for the first time [12] - DecisionDx-SCC delivered 4,186 test reports in Q3 2025, maintaining high volume without proactive marketing [13] - TissueCypher achieved 10,609 test reports in Q3 2025, representing 75% year-over-year growth [16] Market Data and Key Metrics Changes - The target patient population for Advanced AD TX is estimated at approximately 13.2 million individuals aged 12 and older with moderate to severe atopic dermatitis, representing a $33 billion total addressable market opportunity in the US [9][10] - Approximately 80% of clinicians sampled indicated they would likely use Advanced AD TX, highlighting its potential value [10] Company Strategy and Development Direction - The launch of Advanced AD TX is aimed at implementing precision medicine in atopic dermatitis management, with plans for phased clinical availability throughout 2026 [11] - The company is focused on leveraging existing laboratory, logistics, and commercial infrastructure to efficiently introduce Advanced AD TX [10] - Continued emphasis on building education and awareness for TissueCypher to drive adoption and utilization [16] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the strength of the operating model and strategic initiatives, reinforcing the commitment to improving patient care [12][23] - The company expects to maintain positive net cash flow from operations for 2025, supported by strong top-line performance and disciplined expense management [22] Other Important Information - The company is pursuing multiple reimbursement pathways for Advanced AD TX, recognizing the need to build a new market [10] - New peer-reviewed evidence further validates the clinical utility of DecisionDx-SCC, enhancing its role in patient care [14][15] Q&A Session Summary Question: Addressable patient population for Advanced AD TX - Management estimated that around 10-20% of the 13.2 million patients with moderate to severe atopic dermatitis could be of Medicare age [24] Question: Reimbursement pathways for Advanced AD TX - Management indicated that they are exploring various reimbursement options but did not provide specific details at this time [25] Question: Timing and likelihood of SCC reconsideration requests - Management noted that the timing for reconsideration decisions is uncertain and depends on the pace of Medicare contractors [28] Question: Volume outlook for DecisionDx-Melanoma - Management reiterated expectations for high single-digit volume growth for DecisionDx-Melanoma for the full year 2025 [31] Question: Market penetration for TissueCypher - Management acknowledged that they are in the early growth phase for TissueCypher, with ongoing efforts to educate the market and increase adoption [35] Question: FDA approval impact on DecisionDx-Melanoma - Management does not anticipate a change in the Medicare rate due to FDA approval but sees potential long-term benefits from state biomarker laws [39][40]

Empowering people, informing care decisions November 2025 ©2025 Castle Biosciences 1 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 sections. These forward-looking statements include, but are not limited to, statements concerning: our positioning for continued grow ...