Castle Biosciences, Inc. Q4 FY2025 earnings call

• Derek stated they closed out a strong fourth quarter and an outstanding year in 2025 driven by continued momentum across core revenue drivers, discipline execution, and employee dedication. They completed the acquisition of PROVISED, entered into a collaboration and license agreement with Sybase, launched the first - in - class advanced AD TX test, strengthened commercial teams, and solidified the balance sheet. DecisionDx melanoma reached a significant milestone of surpassing 230,000 test orders since launch. - Frank discussed 2025 financial results, including total revenue, gross margin, operating expenses, net loss, adjusted EBITDA, cash flow, and capital expenditures. Mentioned 2026 revenue guidance, expecting operating expenses to increase moderately in 2026 to support core franchises, pipeline, and key initiatives, and the growth plan spanning near, medium, and long term.

In 2025, fourth quarter revenue was $87.0 million, full - year revenue was $344.2 million. Excluding certain revenues, revenue growth for the year was approximately 34%. Total test report volume from core revenue drivers was 105,053, increasing 37% compared to 2024, with tissue cipher report volume achieving 86% growth over 2024. DecisionDx melanoma had 39,083 test reports in 2025, representing 9% year - over - year growth, with 1,795 new - ordering clinicians in 2025 and over 17,000 total ordering clinicians lifetime. TissueCypher delivered 39,014 test reports in 2025, a 86% growth from 2024, and had 2,082 new - ordering clinicians in 2025. ADVANCE - AD - TX was clinically launched in late November 2025 on a limited - access model with early results exceeding expectations, but expected to have immaterial revenue contribution in 2026.

• Anticipated 2026 total revenue of $340 to $350 million, which is growth to mid to high teens over 2025 when excluding certain revenues. - ADVANCE - AD - TX is expected to have immaterial revenue contribution in 2026, with material revenue contribution expected in 2027 or 2028. - Expect to expand clinician access to ADVANCE - AD - TX in a phased manner based on internal metrics. - Expect to communicate more about reimbursement for ADVANCE - AD - TX in the second half of 2026.

Q: Concisely elaborate on the takeaway from the recent NCCN update regarding DecisionDX melanoma, level of confidence in it being included in guidelines, and its importance.

A: The U.S. standard for considering sentinel oftal biopsy surgical procedure has remained 5% not changed in the update. DecisionDX melanoma's low risk result gets below 5%, while the MERLIN - 001 study shows the MERLIN test fails to achieve this threshold. There are 58 peer - reviewed publications for DecisionDX melanoma, but only 11 are cited in the current guidelines.

Q: Timeline on FDA submission for DecisionDX melanoma and its impact on adoption and test volume.

A: Preparing the submission as a de novo 510 submission. Believed clinicians may wait for FDA approval, and newer state biomarker laws may assist in reimbursement, potentially impacting test volume and adoption.

Q: Strategy of sales team approaching derms with ADVANCE - AD - TX, rapid KOL awareness.

A: Limited access launch to approximately 150 dermatological accounts in the U.S., with over half of initial accounts ordering one or more tests in the first five weeks of clinical availability, and over 500 orders by mid - February. The sales team focuses on DecisionDX melanoma with some atopic dermatitis sprinkled in, shifting to a 90, 10% split in the second quarter.

Q: Update on TissueCypher sales reps activity and strategy regarding private equity roll - ups.

A: Continue to add to the TissueCypher sales team, see territories reaching volume levels, think both dermatology and GI specialties shouldn't require more than 100 sales reps. There is interest in large group models for TissueCypher, and volume expansion in 2025 was largely from individual clinicians seeing the value of the test.

Q: Expectations for TissueCypher volume growth in 2026, clinician penetration perspective.

A: Expect growth from further penetration in the existing ordering base or adding new clinicians. In 2024, there were over 1,000 new - ordering physicians, and in 2025 over 2,000, with ~3,000 clinicians, ~11% patient penetration, expecting continued volume growth in 2026.

Q: Thoughts on commercial strategy for derm team if positive draft LCD for DecisionDX SCC is published, splitting reps time between melanoma, SCC, and ADVANCE - AD - TX.

A: If a positive draft LCD for DecisionDX SCC is published, would begin to fold SCC back into the sales bag from a commission standpoint, watch timing. There are tradeoffs in splitting reps' time between the tests, think it's difficult to have three tests sold well by the same person, and will see how SCC draft timing and ADVANCE - AD - TX climb play out.

Q: When NCCN typically updates guidelines for SCC and new data submitted.

A: Believed NCCN typically updates guidelines around the most surgical meeting in May, and the submission last spring included papers showing the benefit to predicting adjuvant radiation therapy responsiveness, which missed the 2020 - 2024 cut - offs, expecting an update between late April and May.