Castle Biosciences Q4 Volume Rises 37% to 105,053 Tests; Guides $340M–$350M in 2026
Castle Biosciences reported 105,053 core test reports in 2025, up 37% year over year, fueled by 86% growth in TissueCypher (39,014 tests) and 9% growth in DecisionDx-Melanoma (39,083 tests). The company delivered $344.2 million in full-year revenue (above guidance) and issued 2026 revenue guidance of $340–350 million.
1. Q4 and Full-Year 2025 Results
Castle Biosciences reported fourth-quarter revenue of $87.0 million and full-year 2025 revenue of $344.2 million, exceeding its guidance range. Full-year net loss was $24.2 million and cash and equivalents stood at approximately $299.5 million at December 31, 2025.
2. Volume Growth and Product Performance
Core test report volume rose 37% to 105,053 in 2025, driven by TissueCypher’s 86% growth to 39,014 reports and DecisionDx-Melanoma’s 9% increase to 39,083 reports. Patient penetration exiting 2025 was cited at roughly 11% for TissueCypher and 31% for DecisionDx-Melanoma.
3. Pipeline Initiatives and Launches
The AdvanceAD-Tx test launched under limited access with about 500 orders by mid-February 2026 but is expected to yield immaterial revenue in 2026. Castle plans to enroll first patients in Q2 2026 for its Previse cell collection device and SciBase EIS collaboration, with preliminary data due by year-end and a DecisionDx-Melanoma de novo 510(k) submission targeted for late 2026.
4. 2026 Outlook and Guidance
Management provided 2026 revenue guidance of $340–350 million, implying mid-to-high teens growth excluding DecisionDx-SCC and IDgenetix. Operating expenses are expected to increase moderately to support core franchises, pipeline advancement and reimbursement initiatives, with fourth-quarter gross margin at 76.3%.