Q2 2026 Castle Biosciences Inc Earnings Call Transcript
Key Points
- Castle Biosciences Inc (CSTL) delivered strong Q2 2026 revenue of $103.5 million, a 20% year-over-year increase, and raised its full-year 2026 revenue guidance to $365-$375 million from $345-$355 million.
- TissueCypher test volume grew 63% year-over-year in Q2 2026, with the company now expecting 50%-52% volume growth for the full year, indicating strong market adoption.
- The company's AdvanceAD-Tx test received a unanimous 21-0 panel vote for a Medicare crosswalk to a code with a favorable rate of $3,675, which is expected to support a full commercial launch.
- A prospective multicenter study published in Q2 demonstrated that DecisionDx-Melanoma outperformed the MIA nomogram in identifying low-risk patients, with an actual sentinel lymph node positivity rate of just 2.6%, well below the NCCN's 5% threshold.
- The company reported positive adjusted EBITDA of $12.4 million for Q2 2026, up from $10.4 million in the prior year, and expects to achieve positive adjusted EBITDA for the full year 2026 and 2027.
- Castle Biosciences Inc (CSTL) maintains a strong balance sheet with $266.8 million in cash and marketable securities, providing financial flexibility to invest in growth initiatives and pipeline opportunities.
- DecisionDx-Melanoma volume growth was moderate at 3% year-over-year in Q2 2026, below historical seasonality, partly due to the commercial team adapting to support three products in the same customer call.
- The company's gross margin declined to 74.9% in Q2 2026 from 77.3% in Q2 2025, and adjusted gross margin fell to 76.3% from 79.5%, reflecting higher costs associated with increased volumes.
- Castle Biosciences Inc (CSTL) reported a net loss of $2.1 million in Q2 2026, compared to net income of $4.5 million in Q2 2025, driven by increased operating expenses.
- The company noted that the stepwise increase in TissueCypher ASP seen in the first half of 2026 is not expected to repeat in the second half, limiting potential revenue upside from pricing.
- There remains uncertainty regarding the timeline for Medicare coverage decisions for DecisionDx-SCC, with no public commentary on data discussions and a potential wait of up to a year after any draft LCD is posted.
- The company acknowledged that as TissueCypher penetration grows, the easier conversions have likely been captured, and future growth may require more effort and potentially higher expenses.
Good afternoon and welcome to the Castle Biosciences second quarter 2026 conference call as a reminder today's call is being recorded. We will begin today's call with opening remarks and introductions followed by a question-and-answer session. I would like to turn the call over to Camilla Zuckero Vice President Investor Relations and Corporate Affairs.
Thank you, operator. Good afternoon, everyone. Welcome to Castle Biosciences' second quarter 2026 results conference call. Joining me today are Castle's Founder, President, and Chief Executive Officer, Derek Maetzold; and Chief Financial Officer, Frank Stokes. Information recorded on this call speaks only as of today, July 30, 2026.
Therefore, if you are listening to the replay or reading the transcript of this call, any time-sensitive information may no longer be accurate. A recording of today's call will be available on the investor relations page of the company's website for approximately three weeks following the
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