Castle Raises 2026 Revenue Outlook After Third-Quarter Gain

The Tip Desk · November 11, 2026 · 3 min read

The diagnostics company now expects $385 million to $395 million in 2026 sales after third-quarter revenue of $102.9 million.

Castle Biosciences (CSTL) raised its 2026 revenue outlook to $385 million to $395 million after third-quarter sales of $102.9 million, up 24% from $83.0 million a year earlier.

The Friendwood, Texas, diagnostics company had previously guided to $365 million to $375 million. It also maintained its expectation of positive Adjusted EBITDA for the fourth quarter of 2026, the full year 2026 and the full year 2027.

TissueCypher Barrett’s Esophagus was the quarter’s volume engine. Test reports rose 47% to 15,574 from 10,609 in the third quarter of 2025. Combined test reports for the company’s core revenue drivers, DecisionDx-Melanoma and TissueCypher, increased 22% year over year, after 32% growth in the second quarter and 36% in the first.

DecisionDx-Melanoma test reports were 10,177, compared with 10,459 a year earlier. The dermatology commercial team delivered 15,168 test reports in the third quarter, including DecisionDx-SCC, AdvanceAD-Tx and other skin-cancer and atopic-dermatitis tests. DecisionDx-SCC reports were 3,882, down from 4,186. MyPath Melanoma reports were 798, down from 1,151. AdvanceAD-Tx contributed 1,109 reports and Esopredict 469; neither test was offered in the third quarter of 2025.

Gross margin was 75% and Adjusted Gross Margin 77%, matching the year-ago quarter. Adjusted EBITDA was $12.7 million, compared with $9.2 million. Net loss was $4.1 million, or $0.13 a share, versus a net loss of $0.5 million, or $0.02 a share, a year earlier. The loss included $11.2 million of non-cash stock-based compensation. Net cash provided by operations was $19.7 million.

President and chief executive officer Derek Maetzold said TissueCypher was a key contributor to top-line performance and that the team delivered another strong quarter reflecting consistent execution across the portfolio.

For the nine months ended September 30, 2026, revenue was $290.1 million, compared with $257.2 million a year earlier. The company said comparisons to 2025 include the change in DecisionDx-SCC Medicare coverage effective April 24, 2025, a re-focus of commercial efforts and the discontinuation of IDgenetix in May 2025. Core-driver test reports in the nine months increased 29%. DecisionDx-Melanoma reports were 30,478 and TissueCypher reports 42,307. Adjusted EBITDA for the nine months was $20.0 million. Net cash provided by operations was $12.8 million.

Cash, cash equivalents and marketable investment securities totaled $277.7 million as of September 30, 2026.

The company opened a 55,000-square-foot laboratory and office facility in Scottsdale, Arizona, and said the investment gives teams additional space, infrastructure and capacity to support current work and anticipated growth. In September, collaboration partner SciBase announced that Castle placed an additional order of about $0.6 million for a portable pen device and electrodes to accelerate an ongoing clinical study and prepare a second study on electrical impedance spectroscopy in atopic dermatitis; deliveries began early in the fourth quarter of 2026.

The company also cited new clinical publications on DecisionDx-Melanoma, DecisionDx-SCC, AdvanceAD-Tx and TissueCypher, including a prospective multi-center melanoma study of 2,799 patients and a Barrett’s esophagus study in which clinicians changed management recommendations 90% of the time after receiving TissueCypher results.