Castle Biosciences, Inc. · NASDAQ:CSTL
Castle Biosciences — Q3 2025 Earnings Presentation
34 slides from Castle Biosciences's earnings presentation, November 2025
Slide 1: Empowering people, informing care decisions
Empowering people, informing care decisions November 2025 ©2025 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, DecisionDx-UM, DecisionDx-PRAME and DecisionDx-UMSeq are trademarks of Castle Biosciences, Inc. ©2025 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 ©2025 Castle Biosciences 5
Slide 6: Key Q3 2025 and recent results
Key Q3 2025 and recent results 1 Q325 total test reports for our core revenue drivers (DecisionDx- 1 Melanoma, TissueCypher) increased 36% over Q324 Gross Margin for Q325 was 75%, and Adjusted Gross Margin was 77%, 2 compared to 79% and 82% respectively for the same periods in 2024 Net cash provided
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 ©2025 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 1 Atopic Dermatitis (AD) Flares Pipeline2 Ophthalmology Pipeline test to diagnose
Slide 9: Expectations for material revenue contribution
Expectations for material revenue contribution Execution across our current test portfolio, a robust pipeline and strategic opportunities supports current and mid- to long-term value creation goals 2026 2027-2028 2029+ * * Atopic Dermatitis- Flares Pipeline test GI Disease Screening/Diagnosis- Pipel
Slide 10: 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 11: Introducing AdvanceAD-Tx
Introducing AdvanceAD-Tx Product A non-invasive gene expression profile test to guide systemic treatment decision making in patients Description with moderate-to-severe atopic dermatitis (AD) Test Mechanism Sample is processed for RNA isolation and transcriptomic profiling, and a proprietary suite o
Slide 12: AdvanceAD-Tx
AdvanceAD-Tx Total Intended Use Launch Details Addressable Reimbursement Population Market (TAM) Strategy AdvanceAD-Tx is being Based on a one-year made commercially Target population Pursuing multiple prevalence, it is available through a represents an reimbursement estimated that there measured, l
Slide 13: Data from the IDENTITY Study
Data from the IDENTITY Study Patients with JAKi Responder Profile who are treated with a JAK inhibitor therapy, compared to those treated with a Th2- targeted therapy achieve the following by 3 months: More likely to achieve a validated More likely to More likely to Achieved a investigator remain fl
Slide 14: DecisionDx-Melanoma provides precise, personalized risk prediction for two critical clinical questions
DecisionDx-Melanoma provides precise, personalized BUILD 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 st
Slide 15: Evidence from prospective studies supporting DecisionDx-Melanoma
Evidence from prospective studies supporting BUILD DecisionDx-Melanoma demonstrates: 1 2 3 Physicians are using DecisionDx- DecisionDx- DecisionDx-Melanoma Melanoma low-risk Melanoma low-risk, to inform clinical test results are Class 1A patients decisions about associated with who forego a SLNB sen
Slide 16: 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 17: DecisionDx-SCC may identify patients who benefit most from ART
DecisionDx-SCC may identify patients who benefit most from ART to control metastatic disease BUILD 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 M
Slide 18: 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 19: TissueCypher provides independent prediction of progression
TissueCypher provides independent prediction of progression n=699 patients1-6, 150 incident progressors, 40 prevalent cases, 509 non-progressors Real world histologic grading TissueCypher risk class 7.8x ↑ risk 2.7x ↑ risk No significant risk stratification 62% progressors detected 1. Critchley-Thor
Slide 20: Financials
Financials ©2025 Castle Biosciences 20
Slide 21: Well positioned for continued value creation
Well positioned for continued value creation Drive robust test volume growth Maintain strong Adjusted Gross Margin Goal to achieve operating cash flow positivity by the end of 2025 Maintain strong balance sheet Follow disciplined capital allocation ©2025 Castle Biosciences 21
Slide 22: Strong test volume growth in our core revenue drivers
Strong test volume growth in our core revenue drivers NET REVENUE BY TYPE ($M) TOTAL TEST VOLUME FOR CORE REVENUE DRIVERS3 Q3 2025 total test reports for our core Q3 2025 Non- revenue drivers $34.5 Dermatologic revenue (DecisionDx- Q3 2025 increased by 67% over 10,609 Q3 2025 10,459 Melanoma, Q3 202
Slide 23: Q3 2025 Financial Highlights
Q3 2025 Financial Highlights Track record of consistent execution and strong business fundamentals Adjusted Total Total Report Adjusted Operating Cash Gross Revenue Volume EBITDA3 Cash Flow Position4 Margin1,2 $83.0M 26,841 76.8% $9.2M $22.6M $287.5M 1. Adjusted Gross Margin is a non-GAAP measure. S
Slide 24: 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 As a lesser priority, strategic opportunities, including within our current therapeutic areas ©2025 Castle Biosciences 24
Slide 25: Appendix
Appendix ©2025 Castle Biosciences 25
Slide 26: DecisionDx-Melanoma
DERMATOLOGY DecisionDx-Melanoma Provides comprehensive, personalized, genomic tumor information to guide management for patients with cutaneous melanoma Clinical Validity, Utility and SLNB Guidance and Demonstrated Patient Patient Outcomes1,2 Outcomes DecisionDx-Melanoma Demonstrated clinical validi
Slide 27: 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 22 peer-reviewed 2024 supp
Slide 28: 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 29: 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 30: 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, 2024 Clinical Practice Guideline utility and impact, backed ack
Slide 31: 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 27 peer-reviewed patients publications, which • Fav
Slide 32: 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 "Use of Non- GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use
Slide 33: 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 "Use of Non-GAAP Financial Measures (UNAUDITED)" above for further information regarding the Company's use of non-GAAP financial measur
Slide 34: Thank You
Thank You ©2025 Castle Biosciences 34