Castle Biosciences Inc (CSTL) · Nov 5, 2026 · Earnings

Castle Biosciences earnings beat as 2026 revenue guidance rises again

Beat — Q3 revenue $102.9M vs ~$92.4M consensus; EPS $(0.13) vs $(0.35) consensus

Castle Biosciences earnings beat on strong TissueCypher growth, prompting another 2026 revenue guidance increase despite continued GAAP losses.

Castle is in the middle of a commercial transition: Medicare’s loss of coverage for DecisionDx-SCC has forced the business to rely more heavily on DecisionDx-Melanoma, TissueCypher and newer tests such as AdvanceAD-Tx. Prior-quarter results showed the core revenue drivers growing quickly and management had already raised 2026 revenue guidance to $365–375 million, so the key question was whether that momentum could continue.

The quarter materially exceeded the published bar. Revenue was $102.9 million versus a published consensus of roughly $92.4 million, while GAAP EPS was a $0.13 loss versus an expected loss of about $0.35 per share. That is a clear earnings beat, not merely a continuation of prior guidance. Q3 revenue increased 23.9% from $83.0 million a year earlier, and Adjusted EBITDA rose to $12.7 million from $9.2 million. The caveat is that GAAP net loss widened to $4.1 million from $0.5 million, partly reflecting equity-security losses and higher operating costs.

FigureQ3 2026Q3 2025Consensus
Revenue (Income Statement)$102.9M (+23.9%)$83.0M~$92.4M
Adjusted EBITDA (Adjusted EBITDA reconciliation)$12.7M (+38.8%)$9.2M
GAAP EPS (Income Statement)$(0.13)$(0.02)~$(0.35)
GAAP net loss (Income Statement)$(4.1M)$(0.5M)
Adjusted gross margin (Non-GAAP reconciliation)76.5%76.8%

TissueCypher is now doing most of the heavy lifting. TissueCypher report volume rose 47% year over year to 15,574, while DecisionDx-Melanoma volume slipped to 10,177 from 10,459 and DecisionDx-SCC also declined. That mix matters: growth is increasingly coming from the gastroenterology franchise rather than a broad-based rebound across Castle’s legacy dermatology portfolio. The filing says, “TissueCypher was a key contributor to our top-line performance, delivering 47% year-over-year growth in test report volume compared to the third quarter of 2025.” 〔0〕

Management raised the outlook again, strengthening the execution signal. 2026 revenue guidance moved to $385–395 million from $365–375 million, lifting the midpoint by $20 million, or about 5.4%; the presentation shows this is the third increase since February, with the midpoint now $45 million above the original range. Management also maintained its expectation for positive Adjusted EBITDA in Q4 2026, full-year 2026 and full-year 2027. 〔1〕

The improvement is not yet a complete profitability story. Nine-month operating cash flow fell to $12.8 million from $37.4 million, Adjusted EBITDA declined to $20.0 million from $32.5 million, and cash plus marketable securities fell to roughly $277.7 million from $299.5 million at year-end. The balance sheet remains substantial relative to the company’s debt, but the filing shows that higher revenue has not yet translated into steadily improving GAAP earnings or cash generation.

Bottom line: This is a clearly better-than-expected quarter and another meaningful upward reset to revenue expectations, driven primarily by TissueCypher. It strengthens Castle’s growth-and-scale story, although the business still needs to convert that growth into durable cash earnings while its dermatology portfolio remains uneven.

What to watch next

Q4 results and full-year 2026 Adjusted EBITDA outcome

Original filing on SEC EDGAR

Castle Biosciences earnings beat as 2026 revenue guidance rises again | CSTL Stock News
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