Castle Biosciences, Inc. · NASDAQ:CSTL
Castle Biosciences — Q1 2026 Earnings Presentation
33 slides from Castle Biosciences's earnings presentation, May 6, 2026
Slide 1: Empowering people, informing care decisions
Empowering people, informing care decisions May 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: First Quarter 2026 Results Highlights
First Quarter 2026 Results Highlights Published new data from a prospective, multicenter study confirming DecisionDx-Melanoma’s i31-SLNB accurately predicts SLN positivity and 1 identifies low-risk patients who may safely consider forgoing SLNB. Patients with a less than 5% predicted risk had an act
Slide 7: Proven strategy designed to drive value creation for our stakeholders
Proven strategy designed to drive value creation for our stakeholders BUILD robust clinical FOCUS evidence on best/first-in-class tests with high, unmet clinical need and significant market opportunity PENETRATE target markets to further test adoption by clinicians and payers ©2026 Castle Bioscience
Slide 8: Answering clinical questions to guide care along the patient journey
Answering clinical questions to guide care along the patient journey DIFFERENTIAL RISK THERAPY RESCUE/ SCREENING DIAGNOSTIC SELECTION SUPPORT STRATIFICATION GUIDANCE PREVENTION SUPPORT Dermatology SciBase Collaboration Atopic Dermatitis (AD) Flares Pipeline1 Pipeline test to diagnose Pipeline test t
Slide 9: 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 10: DecisionDx-Melanoma ~$540M
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 11: 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 12: DECIDE study showed up to 13-fold difference in predicting SLNB positivity
DECIDE study showed up to 13-fold difference in predicting SLNB positivity rates between lowest and highest categories DECIDE study showed up to 13-fold difference in predicting SLNB positivity rates between lowest and highest categories SLN positivity rates by i31-SLNB result Fold Difference <5% 5-
Slide 13: Prospective data confirm i31-SLNB result 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 14: 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 15: TissueCypher provides individualized 5-year risk of progression to HGD or EAC
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 16: 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 17: 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 18: AdvanceAD-Tx guides systemic treatment choice for moderate-to-severe 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 19: AdvanceAD-Tx identifies patients with superior response to JAK inhibitor therapies
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 20: Financials
Financials ©2026 Castle Biosciences 20
Slide 21: First Quarter 2026 Financial Highlights
First Quarter 2026 Financial Highlights Track record of consistent execution and strong business fundamentals Adjusted Total Total Report Adjusted Operating Cash Gross Revenue Volume EBITDA3 Cash Flow4 Position5 Margin1,2 1Q26 $83.7M 26,933 75.6% $(5.1)M $(22.1)M $261.7M 1. Adjusted Gross Margin is
Slide 22: First Quarter 2026 Test Volume Results
First Quarter 2026 Test Volume Results 1Q26 1Q25 Core Revenue Drivers: • DecisionDx-Melanoma 10,021 8,621 • TissueCypher 11,745 7,432 Additional Tests: • DecisionDx-SCC1 3,702 4,375 • MyPath Melanoma 973 926 • DecisionDx-UM 492 470 1. Affecting first quarter ended March 31, 2026 test report volume w
Slide 23: A disciplined approach to capital allocation
A disciplined approach to capital allocation Commercial optimization Focused R&D efforts to build evidentiary support and develop tests Strategic opportunities, including within our current therapeutic areas ©2026 Castle Biosciences 23
Slide 24: Well positioned for continued value creation
Well positioned for continued value creation Drive robust test volume growth Maintain strong Adjusted Gross Margin Maintain strong balance sheet Follow disciplined capital allocation ©2026 Castle Biosciences 24
Slide 25: Appendix
Appendix ©2026 Castle Biosciences 25
Slide 26: DecisionDx-SCC
DERMATOLOGY DecisionDx-SCC Identifies the risk of metastasis in patients with squamous cell carcinoma (SCC) and one or more risk factors Clinical Validity and Utility Real-World Use Framework Demonstrated validity, Several published studies in utility and impact, backed by 24 peer-reviewed 2024 supp
Slide 27: DecisionDx-SCC addresses three critical clinical questions for high-risk SCC patients
DecisionDx-SCC addresses three critical clinical questions for high-risk SCC patients 1 2 3 What is my SCC patient’s What is my NCCN high risk risk of regional or distant SCC patient’s risk of local Is my SCC patient likely to metastasis? recurrence*? benefit from adjuvant radiation therapy (ART)? O
Slide 28: DecisionDx-SCC may identify patients who benefit most from ART
DecisionDx-SCC may identify patients who benefit most from ART to control metastatic disease progression noART: Class 2B ART: Class 2B MEDIAN RISK OF METASTATIC DISEASE PROGRESSION 100 ART: Class 2A • A Class 1 or Class 2A result did not 1.00 noART: Class 2A reflect a significant decrease in MEDIAN
Slide 29: 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 30: 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 31: 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 32: 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 33: Thank You
Thank You ©2026 Castle Biosciences 33