Castle Biosciences, Inc. · NASDAQ:CSTL
Castle Biosciences — Q2 2025 Earnings Presentation
35 slides from Castle Biosciences's earnings presentation, August 2025
Slide 1: Empowering people, informing care decisions
Empowering people, informing care decisions August 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, 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 Q2 2025 and recent results
Key Q2 2025 and recent results 11 Q225 total test reports for our core revenue drivers (DecisionDx®- Melanoma, TissueCypher®) increased 33% over Q224 2 Gross Margin for Q225 was 77%, and Adjusted Gross Margin was 80%, compared to 81% and 83% respectively for the same periods in 2024 Net cash provide
Slide 7: Answering clinical questions to guide care along the patient journey
Answering clinical questions to guide care along the patient journey Our focus is on diagnostic support, risk stratification and therapy selection/response areas of the patient care continuum Diagnostic Rescue/ Risk Therapy Selection/ PATIENT CARE JOURNEY Support Prevention Stratification Response S
Slide 8: Role of Previse acquisition in building GI franchise
Role of Previse acquisition in building GI franchise Diagnostic Risk Therapy Selection/ PATIENT CARE JOURNEY Screening Support Stratification Response GI In-Market GI Pipeline Sponge-based test Sponge-based test Potential to combine spatialomics + DNA methylation for a multiomics approach to patient
Slide 9: Role of SciBase in our AD Pipeline
Role of SciBase in our AD Pipeline up to ~24 million patients diagnosed with AD Mild AD Moderate-to-severe AD Maintenance Maintenance Line of care Topicals Systemic therapies Line of care Rescue/ SciBase Collaboration Rescue/ prevention prevention of flares AD Flares Pipeline of flares Systemic CSTL
Slide 10: CSTL AD Pipeline Test
CSTL AD Pipeline Test Treatment response by 3 months is increased in patients with a JAKi profile using a JAKi vs. patients using a Th2-targeted therapy Result: SOC Th2 profile JAKi profile Result: SOC Th2 profile JAKi profile Result: SOC Th2 profile JAKi profile * P=.032 * P=.016 * P=.012 * P=.043
Slide 11: 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 12: Building evidence showing the value of our tests
Building evidence showing the value of our tests BUILD Data from our Studies2 demonstrating prospective, multicenter that our test can Ablation has been DECIDE study show use improve risk shown to stop of DecisionDx- stratification when used progression to EAC Melanoma can in conjunction with but us
Slide 13: DecisionDx-Melanoma provides precise, personalized risk prediction
DecisionDx-Melanoma provides precise, personalized risk prediction for two critical clinical questions BUILD 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 14: 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 15: DecisionDx-SCC addresses two critical clinical questions
DecisionDx®-SCC addresses two critical clinical BUILD questions 1 2 What is this SCC patient’s Is this SCC patient likely risk of regional or distant to benefit from adjuvant metastasis? radiation therapy (ART)? Overall Event Rate: 13.2%, n=897 Class 1 Class 2A Class 2B Class 1 Class 2A Class 2B Low
Slide 16: 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 17: 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 18: TissueCypher is the strongest independent predictor of progression
TissueCypher is the strongest independent predictor 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) Critchl
Slide 19: Advancing penetration of our tests with clinicians and payers
Advancing penetration of our tests with clinicians and payers PENETRATE Expert Consensus & Reimbursement Castle Commercial Guidelines1 Strategy Playbook Total Test Report Volume • DecisionDx-Melanoma: 2023 • Leader in developing ADLT tests National Society for Cutaneous approved by CMS • Optimizing
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: Drive robust test report volume and revenue growth
Drive robust test report volume and revenue growth Q2 2025 total test volume for our core revenue drivers (DecisionDx-Melanoma, TissueCypher) increased 33% y/y NET REVENUE BY QUARTER ($M) TOTAL TEST VOLUME BY QUARTER 26,5745 26,010 25,102 $87.0 $86.3 $88.0 $86.2 24,0713,4 24,402 $85.8 $18.2 $20.7 $2
Slide 23: Maintain strong Adjusted Gross Margin
Maintain strong Adjusted Gross Margin ADJUSTED GROSS MARGIN BY QUARTER1,2 OPERATING EXPENSES BY QUARTER ($M)3 $28.34 $2.0 $2.2 $2.2 $4.3 83.2% 81.9% 81.1% 81.2% 79.5% $58.6 $58.1 $51.1 $50.5 $50.0 $14.1 $12.3 $11.8 $12.6 $12.8 $14.5 $15.6 $16.2 $16.4 $17.6 Q2 2024 Q3 2024 Q4 2024 Q1 2025 Q2 2025 Q2
Slide 24: Strong operating cash flow and Adjusted EBITDA
Strong operating cash flow and Adjusted EBITDA Cash position of ~$276M1 supports growth initiatives OPERATING CASH FLOW BY QUARTER ($M) ADJUSTED EBITDA BY QUARTER ($M)3,4 $24.0 $24.4 $21.5 $21.6 $21.3 $23.3 $20.8 $13.0 $10.4 $(6.0) Q2 2024 Q3 2024 Q4 2024 Q1 2025 Q2 2025 Q2 2024 Q3 2024 Q4 2024 Q1 2
Slide 25: A disciplined approach to capital allocation
A disciplined approach to capital allocation • Recent TissueCypher Commercial optimization commercial team expansion • ~157 peer-reviewed articles have been published demonstrating the analytical Focused R&D efforts to build evidentiary validity, clinical validity and support and develop tests clini
Slide 26: Appendix
Appendix ©2025 Castle Biosciences 26
Slide 27: 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 28: 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 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 publications demon
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: Atopic Dermatitis Gene Expression Profile Test
PIPELINE Atopic Dermatitis Pipeline Program Atopic Dermatitis Gene Expression Profile Test Test currently in development for use in patients diagnosed with moderate-to-severe atopic dermatitis (AD) who are seeking systemic treatment Pipeline test has shown potential to identify the Past and Anticipa
Slide 33: 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 34: 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 35: Thank You
Thank You ©2025 Castle Biosciences 35