Castle Biosciences, Inc.

Revenue was $103.5 million in Q2 2026, up 20% versus Q2 2025. Gross margin was 74.9% versus 77.3% a year ago; adjusted gross margin was 76.3% versus 79.5%. Diluted loss per share was $0.07 versus diluted EPS of $0.15 in Q2 2025, and net loss was $2.1 million versus net income of $4.5 million. Adjusted EBITDA was $12.4 million versus $10.4 million a year ago. For the full year 2026, management raised revenue guidance to $365 million to $375 million from $345 million to $355 million, and continues to expect adjusted gross margin in the low to mid-70s and positive adjusted EBITDA in Q3, Q4, and full-year 2026.

Derek Maetzold characterized the quarter as "great" and said the team executed well across revenue, evidence development, and clinical research. He emphasized that Castle is investing in commercial resources, clinical evidence, pipeline opportunities, and lab capacity while maintaining disciplined capital allocation. His tone was confident and upbeat, with repeated comments that the company has momentum into the second half of 2026 and long-term growth opportunities across dermatology and gastroenterology.

Frank Stokes highlighted the main financial drivers: stronger TissueCypher volume, plus some improvement in ASP partly due to modifications in accrual processes implemented earlier this year. He said gross margin was 74.9% and adjusted gross margin was 76.3%, and noted that full-year adjusted gross margin should remain in the low to mid-70s. He also detailed higher operating costs from headcount, travel, lab supplies, and lab services tied to higher test volumes, while saying Castle generated $15.2 million of operating cash flow in the quarter and ended June 30 with $266.8 million of cash, cash equivalents, and marketable investment securities.

Analysts focused heavily on TissueCypher momentum, AdvanceAD-Tx commercialization, SCC re-acceleration, and reimbursement. Management said TissueCypher’s growth is still early in its penetration curve, though it will eventually face bigger-number headwinds, and that recent volume strength reflects steady multi-quarter penetration rather than a one-quarter spike. On AdvanceAD-Tx, management pointed to the unanimous panel vote and the $3,675 crosswalk rate as a favorable reimbursement step, and said they are still phasing the launch while building demand and payer confidence. On SCC, management said the pickup came from existing customer clinical use, more working days in Q2, and some renewed sales-force attention, while on ACA disenrollment they said they do not have visibility to isolate any impact on volumes or collections.