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Castle Biosciences, Inc. (Nasdaq: CSTL) is a diagnostics company specializing in molecular diagnostic testing to improve health outcomes. The company develops and sells innovative tests that assist clinicians in diagnosing and treating various conditions, including dermatologic cancers, Barrett’s esophagus, uveal melanoma, and mental health disorders. Castle Biosciences is committed to advancing disease management through its portfolio of diagnostic solutions and ongoing research and development efforts.
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Dermatologic Tests - Provides diagnostic solutions for skin cancers, including DecisionDx-Melanoma, DecisionDx-SCC, MyPath Melanoma, and DiffDx-Melanoma, aiding clinicians in treatment decisions.
- DecisionDx-Melanoma - Assesses the risk of metastasis in melanoma patients.
- DecisionDx-SCC - Evaluates the risk of metastasis in squamous cell carcinoma patients.
- MyPath Melanoma and DiffDx-Melanoma - Helps differentiate between benign and malignant skin lesions.
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Non-Dermatologic Tests - Offers diagnostic tests for conditions beyond dermatology, including Barrett’s esophagus, uveal melanoma, and mental health disorders.
- TissueCypher Barrett’s Esophagus Test - Identifies patients at high risk of progression to esophageal cancer.
- DecisionDx-UM - Provides prognostic information for uveal melanoma patients.
- IDgenetix - Guides treatment decisions for mental health conditions.
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Research and Development Programs - Focuses on developing new tests for diseases with high clinical need, such as systemic therapy selection for atopic dermatitis, psoriasis, and related conditions.
| Name | Position | External Roles | Short Bio | |
|---|---|---|---|---|
Derek J. Maetzold ExecutiveBoard | Founder, President, Chief Executive Officer (CEO) | Director of PreludeDx; Director of Coalition for 21st Century Medicine; Director of IMPACT Melanoma | Derek J. Maetzold is the CEO of Castle Biosciences since September 2007 and has served on its board from inception. He also has been recognized as a Class III Director Nominee for election at the 2028 Annual Meeting, underscoring his leadership role. | View Report → |
Frank Stokes Executive | Chief Financial Officer | Director of Exagen Inc.; Chair of Audit Committee at Exagen Inc. | Frank Stokes is the Chief Financial Officer at Castle Biosciences since December 2017. He also holds an external board role as Director and serves as Chair of the Audit Committee at Exagen Inc.. | |
Kristen M. Oelschlager Executive | Chief Operating Officer | Kristen M. Oelschlager has been the Chief Operating Officer at Castle Biosciences since April 2021. She previously held roles as Chief Operations Officer, Senior Vice President of Clinical Operations, Vice President of Clinical Operations, and Executive Director of Operations. | ||
Tobin W. Juvenal Executive | Chief Commercial Officer | Tobin W. Juvenal is the Chief Commercial Officer at Castle Biosciences since August 2020, and previously served as Senior Vice President of Sales from October 2008 to August 2020. He also held management roles at Encysive Pharmaceuticals Inc. (Vice President of Sales from December 2005 to June 2007) as well as positions at deCODE Genetics, Genzyme Pharmaceuticals, and Genetics Institute. | ||
Daniel M. Bradbury Board | Chairperson of the Board of Directors | Executive Chairman at Equillium, Inc.; Founder and Managing Member at BioBrit, LLC; Board Member at Equillium, Inc.; Board Member at Vivani Medical Inc. | Daniel M. Bradbury has served as a board member at CSTL since September 2012 and as Chairperson of the Board since September 2014. He holds extensive leadership experience in the life sciences industry, including current executive roles at Equillium, Inc. and as Founder and Managing Member of BioBrit, LLC. | |
Ellen Goldberg Board | Independent Director | Founder and President of CHORD Consulting | Ellen Goldberg is an Independent Director at Castle Biosciences since July 2021, and she brings extensive experience in life sciences and diagnostics from previous leadership roles, including her ongoing role as Founder and President of CHORD Consulting and past roles at Crescendo Bioscience and Genomic Health. | |
G. Bradley Cole Board | Member of the Board of Directors | Member of the Board of Directors at Kiniksa Pharmaceuticals (since July 2020, Audit Committee member at Kiniksa Pharmaceuticals) | G. Bradley Cole has been serving as an independent director at CSTL since December 2018 and holds roles as Chair of the Audit Committee and member of the Compensation Committee. | |
Kimberlee S. Caple Board | Member of the Board of Directors | Kimberlee S. Caple is an independent board member at Castle Biosciences since July 2021. Previously, she held several senior roles at Thermo Fisher Scientific Inc., including serving as President of the Genetic Science Division until March 2025. | ||
Miles D. Harrison Board | Independent Director | Miles D. Harrison has served as an Independent Director on the Board of Directors at CSTL since April 2020. He chairs the Compensation Committee and serves on the Nominating and Corporate Governance Committee, bringing extensive expertise from the pharmaceutical and healthcare industries. | ||
Rodney Cotton Board | Class II director | Board member on various privately held pharmaceutical, life sciences, venture capital, and technology companies | Rodney Cotton has served as a Class II director at CSTL since March 26, 2024. He brings extensive leadership experience in the life sciences industry, previously holding senior executive roles at Roche Diagnostics. | |
Tiffany P. Olson Board | Independent Director | Board Member at Langham Logistics; Board Member at The Education and Research Foundation for Nuclear Medicine and Molecular Imaging; Board Member at Telix Pharmaceuticals; Board Member at MIMEDX; Partner at Trusted Health Advisors | Tiffany P. Olson has served as an Independent Director at Castle Biosciences since May 2021, overseeing the Audit, Compensation, and Nominating & Corporate Governance Committees. She has an extensive background in healthcare leadership, having served as President at Cardinal Health’s Nuclear & Precision Health Solutions, President at NaviMed, a Diagnostics Leader at Eli Lilly, and CEO/President at Roche Diagnostics. |
- Given the anticipated loss of Medicare reimbursement for DecisionDx-SCC effective April 24, 2025, what specific cost structure adjustments and margin protection strategies are you implementing to offset the negative impact on overall revenue and profitability?
- With plans to shift nearly 100% of the dermatology salesforce focus toward DecisionDx-Melanoma beginning May 1, can you detail the expected quantifiable impact on market penetration and revenue growth as a result of this strategic reallocation?
- As TissueCypher volume is projected to remain significant in 2025 despite the impressive 130% growth in 2024, what operational or execution challenges do you foresee in scaling this test, and how will you ensure sustained clinician adoption amid competitive pressures?
- In light of the robust new clinician adoption for DecisionDx-Melanoma and the existing sweet-spot usage pattern among current customers, what specific measures will you take to expand adoption into underpenetrated patient segments or regions?
- Regarding your capital allocation strategy and exploration of strategic opportunities across existing and new verticals, what rigorous criteria do you deploy to balance immediate revenue generation with long-term profitability, and how might these criteria shift in response to evolving reimbursement dynamics?
Competitors mentioned in the company's latest 10K filing.
| Company | Description |
|---|---|
SkylineDx/Tempus/Quest | The company faces competition from a limited number of companies working in the melanoma disease space. |
AMLo/Avero | The company faces competition from a limited number of companies working in the melanoma disease space. |
Neracare | The company faces competition from a limited number of companies working in the melanoma disease space. |
Previse | The company faces competition for the TissueCypher test from companies in the GERD screening space. |
Interpace Diagnostics | The company faces competition for the TissueCypher test from companies in the GERD screening space. |
Lucid Diagnostics | The company faces competition for the TissueCypher test from companies in the GERD screening space. |
DecisionDx-UM competes with a subsidiary of LabCorp and several academic laboratories, all of which have had tests available for several years. | |
IDgenetix competes with Myriad Genetics's GeneSight test. | |
Genomind | IDgenetix competes with Genomind's PGx test. |
| Customer | Relationship | Segment | Details |
|---|---|---|---|
Medicare | Reimbursements for diagnostic testing services | All | 47% of total revenues in 2024 , 49% in 2023 , 53% in 2022 ; accounted for 18% of current A/R in 2024 , 20% in 2023. |
Payor A | Reimbursements for diagnostic testing services | All | 15% of total revenues in 2024 , 14% in 2023 , 12% in 2022 ; accounted for 19% of current A/R in 2024 , 19% in 2023. |
Payor B | Reimbursements for diagnostic testing services | All | Less than 10% of total revenues in 2024 ; accounted for 20% of current A/R in 2024 , 10% in 2023 , 12% of noncurrent A/R in 2024 , 11% in 2023. |
Notable M&A activity and strategic investments in the past 3 years.
| Company | Year | Details |
|---|---|---|
AltheaDx, Inc. | 2022 | Castle Biosciences acquired AltheaDx for an initial $65.0 million (split evenly between cash and common stock) with up to an additional $75.0 million in contingent payments for milestone achievements; the deal, completed on April 26, 2022, strategically enhanced its molecular diagnostics portfolio through AltheaDx’s IDgenetix test for mental health applications. |
Cernostics, Inc. | 2021 | Castle Biosciences acquired Cernostics for a total deal value of $80 million (including $30 million upfront cash and up to $50 million in milestone payments), which expanded its U.S. total addressable market by about $1 billion via the TissueCypher® Barrett’s Esophagus Assay; the deal, completed on December 3, 2021, ensured the retention of Cernostics’ operations and management in Pittsburgh. |
Myriad myPath Laboratory | 2021 | Castle Biosciences acquired Myriad myPath Laboratory for $32.5 million to complement its DecisionDx DiffDx-Melanoma offering, leveraging the CLIA-certified lab’s myPath Melanoma 23-gene expression profile test; the acquisition, completed on May 28, 2021, was financed using existing cash and is intended to expand its comprehensive molecular testing solutions for challenging melanocytic lesions. |
Recent press releases and 8-K filings for CSTL.
- Q1 2025 revenue reached $88M, up 21% YoY driven by robust test volume growth—including a 117% increase in TissueCypher reports, 24,402 test reports, and over 200,000 DecisionDx-Melanoma orders
- Raised full-year revenue guidance to $287–$297M (from prior $280–$295M) amid operating expense adjustments from a one‐time amortization expense due to discontinuing IDgenetix
- Announced definitive agreement to acquire Previse to enhance its gastrointestinal diagnostics portfolio with a complementary methylation-based assay
- Reported a net loss of $25.8M, an adjusted EBITDA of $13.0M, achieved an 81% adjusted gross margin, with net cash use of $6.0M (down from $6.8M) and maintained a cash position of $275.2M
- Full-year revenue reached $332M (51% increase over 2023) with 96,071 test reports delivered and a strengthened cash position of $293M
- Q4 2024 revenue reached $86.3M (up 31% YoY)
- Demonstrated robust Q4 test volume growth with 24,071 total reports, including 36,008 DecisionDx-Melanoma reports, a 43% increase in DecisionDx-SCC reports, and a 130% surge in TissueCypher tests
- Maintained strong operating performance with an Adjusted Gross Margin of 81.1% and Q4 operating cash flow of $24.4M
- Achieved a 52% 5-year CAGR in revenue
- Provided 2025 guidance for total revenue of $280–295M, noting impacts from anticipated Medicare reimbursement changes
- Castle Biosciences reported its preliminary unaudited results for Q4 2024, with total test reports of 24,071 in the quarter, showing significant growth compared to Q4 2023.
- For the full year 2024, the company delivered 96,071 total test reports—a 36% increase year-over-year—and expects revenues to reach or exceed $320-330 million.
- The year-end liquidity position was strong with forecasted cash, cash equivalents, and marketable investments of approximately $293 million.