# EDGAR Filing Document

**Accession Number:** 0001447362
**File Stem:** 0001447362-23-000007
**Filing Date:** 2023-1
**Character Count:** 48845
**Document Hash:** ccb6becda34fb6207c83723e8a530feb
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001447362-23-000007.hdr.sgml**: 20230109

**ACCESSION NUMBER**: 0001447362-23-000007

**CONFORMED SUBMISSION TYPE**: 8-K

**PUBLIC DOCUMENT COUNT**: 73

**CONFORMED PERIOD OF REPORT**: 20230108

**ITEM INFORMATION**: Results of Operations and Financial Condition

**ITEM INFORMATION**: Regulation FD Disclosure

**ITEM INFORMATION**: Financial Statements and Exhibits

**FILED AS OF DATE**: 20230109

**DATE AS OF CHANGE**: 20230109

**FILER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** CASTLE BIOSCIENCES INC
- **CENTRAL INDEX KEY:** 0001447362
- **STANDARD INDUSTRIAL CLASSIFICATION:** SERVICES-MEDICAL LABORATORIES [8071]
- **IRS NUMBER:** 770701774
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 8-K
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-38984
- **FILM NUMBER:** 23517005

**BUSINESS ADDRESS:**
- **STREET 1:** 505 S FRIENDSWOOD DRIVE
- **STREET 2:** SUITE 401
- **CITY:** FRIENDSWOOD
- **STATE:** TX
- **ZIP:** 77546
- **BUSINESS PHONE:** 866-788-9007

**MAIL ADDRESS:**
- **STREET 1:** 505 S FRIENDSWOOD DRIVE
- **STREET 2:** SUITE 401
- **CITY:** FRIENDSWOOD
- **STATE:** TX
- **ZIP:** 77546

?xml version="1.0" ? cstl-20230108

**UNITED STATES**

**SECURITIES AND EXCHANGE COMMISSION**

**Washington, D.C. 20549**

**FORM 8-K**

**CURRENT REPORT**

**Pursuant to Section 13 or 15(d)**

**of the Securities Exchange Act of 1934**

**Date of Report (Date of earliest event reported): January 8, 2023**

**Castle Biosciences, Inc.**

**(Exact name of registrant as specified in its charter)**

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| | | |
|:---|:---|:---|
| **Delaware** | **001-38984** | **77-0701774** |
| **(state or other jurisdiction<br>of incorporation)** | **(Commission<br>File Number)** | **(I.R.S. Employer<br>Identification No.)** |

---

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| | |
|:---|:---|
| **505 S. Friendswood Drive, Suite 401**<br>**Friendswood, Texas** | **77546** |
| **(Address of principal executive offices)** | **(Zip Code)** |

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**Registrant's telephone number, including area code: (866) 788-9007**

**(Former name or former address, if changed since last report.)**

Check the appropriate box below if the Form 8-K filing is intended to simultaneously satisfy the filing obligation of the registrant under any of the following provisions:

☐&nbsp;&nbsp;&nbsp;&nbsp;Written communications pursuant to Rule 425 under the Securities Act (17 CFR 230.425)

☐&nbsp;&nbsp;&nbsp;&nbsp;Soliciting material pursuant to Rule 14a-12 under the Exchange Act (17 CFR 240.14a-12)

☐&nbsp;&nbsp;&nbsp;&nbsp;Pre-commencement communications pursuant to Rule 14d-2(b) under the Exchange Act (17 CFR 240.14d-2(b))

☐&nbsp;&nbsp;&nbsp;&nbsp;Pre-commencement communications pursuant to Rule 13e-4(c) under the Exchange Act (17 CFR 240.13e-4(c))

Securities registered pursuant to Section 12(b) of the Act:

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| | | |
|:---|:---|:---|
| **Title of each class** | **Trading Symbol(s)** | **Name of each exchange on which registered** |
| **Common Stock, $0.001 par value per share** | **CSTL** | **The Nasdaq Global Market** |

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Indicate by check mark whether the registrant is an emerging growth company as defined in as defined in Rule 405 of the Securities Act of 1933 (§ 230.405 of this chapter) or Rule 12b–2 of the Securities Exchange Act of 1934 (§ 240.12b–2 of this chapter).

Emerging growth company ☐

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

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**Item 2.02&nbsp;&nbsp;&nbsp;&nbsp;Results of Operations and Financial Condition.**

On January 8, 2023, Castle Biosciences, Inc. (the "Company") issued a press release announcing certain preliminary performance results for the fourth quarter of 2022 and for the year ended December 31, 2022. A copy of the press release is attached hereto as Exhibit 99.1 and incorporated herein by reference.

The information contained or incorporated in this Current Report on Form 8-K, including Exhibit 99.1, shall not be deemed "filed" for purposes of Section 18 of the Securities Exchange Act of 1934, as amended (the "Exchange Act"), or otherwise subject to the liabilities of that section, nor shall it be deemed to be incorporated by reference into any filing under the Exchange Act or the Securities Act of 1933, as amended (the "Securities Act"), except as expressly set forth by specific reference in such filing to this Current Report on Form 8-K.

**Item 7.01&nbsp;&nbsp;&nbsp;&nbsp;Regulation FD Disclosure.**

On January 9, 2023, the Company made available the slide presentation attached hereto as Exhibit 99.2. Information from this slide presentation may also be used by the management of the Company in future meetings regarding the Company.

The information contained or incorporated in this Item 7.01 of this Current Report on Form 8-K, including Exhibit 99.2, shall not be deemed "filed" for purposes of Section 18 of the Exchange Act or otherwise subject to the liabilities of that section, nor shall it be deemed to be incorporated by reference into any filing under the Exchange Act or the Securities Act except as expressly set forth by specific reference in such filing to this Current Report on Form 8-K.

**Item 9.01&nbsp;&nbsp;&nbsp;&nbsp;Financial Statements and Exhibits.**

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;(d) Exhibits.

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| | |
|:---|:---|
| **Exhibit**<br>**Number** |<br>**Description** |
| 99.1 | <u>[Press release issued January 8, 2023.](cstlprelimresultsq42022.htm)</u> |
| 99.2 | <u>[Slide presentation.](castlebiosciencesq42022-.htm)</u> |
| 104 | Inline XBRL for the cover page of this Current Report on Form 8-K. |

---

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| |
|:---|
| **SIGNATURES** |
| Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has caused this report to be signed on its behalf by the undersigned hereunto duly authorized. |

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| | | |
|:---|:---|:---|
| | **CASTLE BIOSCIENCES, INC.** | **CASTLE BIOSCIENCES, INC.** |
| | By: | /s/ Frank Stokes |
| | | Frank Stokes |
| | | Chief Financial Officer |
| Date: January 9, 2023 |  |  |

---

## Exhibit 99.1

**EXHIBIT 99.1**

![image_0a.jpg](image_0a.jpg)

**<u>Castle Biosciences Announces Preliminary Fourth Quarter and Full-Year 2022 Results</u>**

*2022 total revenue expected to meet or exceed top end of guided range of $132*–*137 million*

*Delivered 44,338 total test reports in 2022, an increase of 58% compared to 2021*

*Growth of 37% year over year in DecisionDx*<sup>®</sup>*-Melanoma test report volume*

*Year-end 2022 cash, cash equivalents and marketable investment securities expected to be approximately $259 million*

**FRIENDSWOOD, Texas- Jan. 8, 2023--**Castle Biosciences, Inc. (Nasdaq: CSTL), a company improving health through innovative tests that guide patient care, today announced certain unaudited preliminary performance results for the fourth quarter and full-year ended Dec. 31, 2022.

"2022 was a year of focused investment, and we believe our strong success across the organization, including in revenue and test report volume growth, was a result of exceptional execution on our initiatives," said Derek Maetzold, president and chief executive officer of Castle Biosciences. "These initiatives include our acquisitions and planned integration of both Cernostics and AltheaDx, continued evidence development to support our commercial and pipeline tests and the expansion of our commercial team. And as such, we expect to meet or exceed the top end of our 2022 revenue guidance of $132-137 million."

**Preliminary, Unaudited Fourth Quarter Ended Dec. 31, 2022, Highlights**

• Delivered 12,563 total test reports in the fourth quarter of 2022, compared to 8,242 in the same period of 2021, an increase of 52%:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx<sup>®</sup>-Melanoma test reports delivered in the quarter were 7,295, compared to 5,635 in the fourth quarter of 2021, an increase of 29%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx<sup>®</sup>-SCC test reports delivered in the quarter were 1,844, compared to 1,265 in the fourth quarter of 2021, an increase of 46%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ MyPath<sup>®</sup> Melanoma and DiffDx<sup>®</sup>-Melanoma diagnostic gene expression profile (GEP) aggregate test reports delivered in the quarter were 822, compared to 904 in the fourth quarter of 2021, a decrease of 9%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx<sup>®</sup>-UM test reports delivered in the quarter were 432, compared to 438 in the fourth quarter of 2021, a decrease of 1%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ TissueCypher<sup>®</sup> Barrett's Esophagus test reports delivered in the quarter were 996. No test reports were delivered by Castle in the fourth quarter of 2021.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ IDgenetix<sup>®</sup> test reports delivered in the quarter were 1,174. No test reports were delivered by Castle in the fourth quarter of 2021.

**Preliminary, Unaudited Year- Ended Dec. 31, 2022, Highlights**

• The Company expects to meet or exceed the top end of its previously guided range of $132–137 million for full-year 2022 total revenue.

• Total test reports delivered in 2022 were 44,338, compared to 28,118 in the same period of 2021, an increase of 58%:

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx-Melanoma test reports delivered in 2022 were 27,797, compared to 20,328 in 2021, an increase of 37%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx-SCC test reports delivered in 2022 were 5,966 compared to 3,510 in 2021, an increase of 70%.

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&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ MyPath Melanoma and DiffDx-Melanoma diagnostic GEP aggregate test reports delivered in 2022 were 3,561, compared to 2,662 in 2021, an increase of 34%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ DecisionDx-UM test reports delivered in 2022 were 1,711, compared to 1,618 in 2021, an increase of 6%.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ TissueCypher Barrett's Esophagus test reports delivered in 2022 were 2,094. No test reports were delivered by Castle in 2021.

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;◦ IDgenetix test reports delivered in 2022 were 3,209. No test reports were delivered by Castle in 2021.

**Revenues and Test Report Volumes Disclaimer**

The effects of macroeconomic events and conditions, including inflation, the COVID-19 pandemic and geopolitical events, among others, continue to evolve and bring along with them a high level of uncertainty surrounding potential future effects. Therefore, trends in revenues and test report volumes are not necessarily indicative of the Company's results of operations that can be expected for future fiscal periods.

**Cash, Cash Equivalents and Marketable Investment Securities**

Year-end 2022 cash and cash equivalents are expected to be approximately $123 million. Additionally, the Company expects to hold approximately $136 million in short-term investments.

Castle Biosciences has not completed the preparation of its financial statements for the fourth quarter or full-year-ended Dec. 31, 2022. The preliminary, unaudited information presented in this press release for the quarter and year-ended Dec. 31, 2022, is based on management's initial review of the information presented and its current expectations, and is subject to adjustment as a result of, among other things, the completion of the Company's end-of-period reporting processes and related activities, including the audit by the Company's independent registered public accounting firm of the Company's financial statements. As such, any financial information contained in this press release may differ materially from the information reflected in the Company's financial statements as of and for the year-ended Dec. 31, 2022. Additional information and disclosures would be required for a more complete understanding of the Company's financial position and results of operations as of and for the quarter and year-ended Dec. 31, 2022. Accordingly, undue reliance should not be placed on this preliminary information.

**About Castle Biosciences**

Castle Biosciences (Nasdaq: CSTL) is a leading diagnostics company improving health through innovative tests that guide patient care. The Company aims to transform disease management by keeping people first: patients, clinicians, employees and investors.

Castle's current portfolio consists of tests for skin cancers, uveal melanoma, Barrett's esophagus and mental health conditions. Additionally, the Company has active research and development programs for tests in other diseases with high clinical need, including its test in development to predict systemic therapy response in patients with moderate-to-severe psoriasis, atopic dermatitis and related conditions. To learn more, please visit www.CastleBiosciences.com and connect with us on LinkedIn, Facebook, Twitter and Instagram.

DecisionDx-Melanoma, DecisionDx-CM*Seq*, DecisionDx-SCC, MyPath Melanoma, DiffDx-Melanoma, DecisionDx-UM, DecisionDx-PRAME, DecisionDx-UM*Seq*, TissueCypher and IDgenetix are trademarks of Castle Biosciences, Inc.

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**Forward-Looking Statements** 

**Investor Relations Contact:** 

Camilla Zuckero

czuckero@castlebiosciences.com

281-906-3868

**Media Contact:** 

Allison Marshall

amarshall@castlebiosciences.com

###

## Exhibit 99.2

![](castlebiosciencesq42022-001.jpg)

January 9, 2023 Transforming Disease Management

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![](castlebiosciencesq42022-002.jpg)

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![](castlebiosciencesq42022-003.jpg)

January 9, 2023 Preliminary Q4 2022 Information

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![](castlebiosciencesq42022-004.jpg)

4 Castle Is Focused on Improving Health through Innovative Tests That Guide Patient Care Gastroenterology Mental HealthUveal MelanomaDermatology Answering clinical questions to guide care along the patient journey

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![](castlebiosciencesq42022-005.jpg)

5 Preliminary Fourth Quarter and Year-end 2022 Performance Results1,2 (unaudited) Expect to meet or exceed top end of guided range of $132–$137M3 for 2022 total revenue 1Castle expects to report its audited consolidated financial statements and complete financial and operational results for its fiscal year ended December 31, 2022, in February 2023. 2The effects of macroeconomic events and conditions continue to evolve and bring along with them a high level of uncertainty surrounding potential future effects. Therefore, trends in revenues and test report volumes are not necessarily indicative of our results of operations that can be expected for future fiscal periods. 3Castle previously provided guidance for full-year 2022 total revenue of $132–$137 million. 4Q22 4Q21 2022 2021 Revenue To be announced $25.0M Expected to meet or exceed top end of guided range2 $94.1M Total test reports 12,563 8,242 44,338 28,118 DecisionDx-Melanoma 7,295 5,635 27,797 20,328 DecisionDx-SCC 1,844 1,265 5,966 3,510 DGEP(MyPath/Diff-Dx) 822 904 3,561 2,662 DecisionDx-UM 432 438 1,711 1,618 TissueCypher 996 2,094 IDgenetix 1,174 3,209

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![](castlebiosciencesq42022-006.jpg)

6 2022 Year-end Cash, Cash Equivalents & Marketable Investment Securities Expected To Be Approximately $259 million1 Cash, Cash Equivalents and Marketable Investment Securities As of 3/31/22 $309M As of 6/30/22 $273M As of 9/30/22 $266M As of 12/31/22 ~$259M (expected) 1This amount is preliminary, unaudited and subject to adjustment as a result of, among other things, the completion of financial closing procedures, including the audit by our independent registered public accounting firm of our financial statements. As a result, amounts may differ from the amount that will be reflected in our financial statements as of and for the year-ended December 31, 2022. Accordingly, undue reliance should not be placed on this preliminary information.

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![](castlebiosciencesq42022-007.jpg)

Third Quarter 2022 November 2, 2022 Transforming Disease Management

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![](castlebiosciencesq42022-008.jpg)

8 Financial Performance Summary Q3 2022 7,727 7,352 12,114 9,824 31,775 27,363 Total test reports Total Derm test reports 3Q21 3Q22 Nine Months Ended September 30, 2022 1See Non-GAAP reconciliations at the end of this presentation. 2Cash use includes acquisitions of AltheaDx and Cernostics. $23.5M $23.6M $37.0M $37.3M $98.7M $100.6M Revenue Adj. Revenue1 77.9% 80.9% 69.8% 76.2% 71.1% 77.6% Gross Margin Adj. Gross Margin1 $(6.1)M $(3.0)M $(5.2)M $(5.2)M $(35.7)M $(35.7)M Operating Cash Flow Adj. Operating Cash Flow1 $363M $266M2 Cash, Cash Equivalents & Marketable Investment Securities as of end of period

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![](castlebiosciencesq42022-009.jpg)

9 Mission Improving health through innovative tests that guide patient care Vision To transform disease management by keeping people first: patients, clinicians, employees and investors Values ExCIITE: Excitement, Collaboration, Integrity, Innovation, Trust and Excellence

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![](castlebiosciencesq42022-010.jpg)

10 Three Strategic Guideposts That Create Value for Customers, Patients and Stockholders Continuous Evolution & Improvement Exceptional Employees Customer & Solution Centric We hire and keep the right people, by Castle's commitment to doing the right thing for employees and nurturing our thriving culture We are an industry leader by challenging the status quo with deep scientific expertise, unique value insight, and robust data development We value best-in-class customer experience at all points along the testing journey, and we leverage multiple solutions for a single customer to provide a single source of high quality molecular diagnostic tests

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![](castlebiosciencesq42022-011.jpg)

11 Driving Long-Term Growth through Strong Execution and our Operational Guideposts Dermatology Mental Health Gastrointestinal Strategic Opportunities Pipeline Expansion (Expected Launches by 2025) Mental Health Gastrointestinal Strategic Opportunities Near- to Mid-term Growth Mid- to Long-term Growth Dermatology Exceptional Employees, Continuous Evolution & Improvement and Customer & Solution Centric

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![](castlebiosciencesq42022-012.jpg)

12 Answering Clinical Questions to Guide Care along the Patient Journey Our focus is on diagnostic support, risk stratification and therapy response areas of the patient care continuum Dermatology Uveal Melanoma Gastroenterology Mental Health Screening Diagnostic Support Risk Stratification Therapy Resource MRD/Recurrence MonitoringPATIENT CARE JOURNEY Inflammatory Skin Disease Pipeline Test

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![](castlebiosciencesq42022-013.jpg)

13 Estimated ~$8B U.S. Total Addressable Market1 for Commercially Available Tests Dermatology Gastroenterology Mental Health Cutaneous melanoma/ risk of metastasis, SLNB positivity risk Patients classified as Stage I, II or III2 ~$540M ~130K Cutaneous squamous cell carcinoma/risk of metastasis Patients w/high-risk features2 ~$820M ~200K Suspicious pigmented lesions/melanoma status Patients w/ diagnostically ambiguous lesions ~$600M ~300K Barrett's esophagus/risk of progression to esophageal cancer Patients receiving upper GI endoscopies/year who meet the intended use criteria for TissueCypher3 ~$1B ~415K Mental health therapy response Based on indicated use of IDgenetix for patients diagnosed with depression, anxiety and other mental health conditions ~$5B Tests in pipeline add an additional estimated ~$3.6B to our U.S. TAM ($1.9B for inflammatory skin disease pipeline test and ~1.7B for additional dermatology pipeline tests) 1U.S. TAM = Total addressable market based on estimated patient population assuming average reimbursement rate among all payors.2Annual U.S. incidence for Stage I, II or III melanoma estimated at 130,000; annual U.S. incidence for squamous cell carcinoma estimated at 1,000,000 with addressable market limited to carcinomas with one or more high risk features; annual U.S. incidence for suspicious pigmented lesion biopsies estimated at 2,000,000 with addressable market limited to the 15% with an indeterminant biopsy.3415,000 upper GI endoscopies/year with confirmed dx of BE (ND, IND, LGD, EXCLUDING HGD) x $2,513 = U.S. only TAM of ~$1 billion

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![](castlebiosciencesq42022-014.jpg)

14 Committed to Delivering Long-term Growth with Net Operating Cash Flow Positivity by 2025 Three-year plan (2025) Revenue 25-35% year-over-year growth1; Total revenue in 2025 of $255m-$330m Adjusted Gross Margins 80%-85% by 2025 Other Operating Expenses2 75%-85% of revenue by 2025 Net Operating Cash Flow Positive3 1Year-over-year revenue growth starting in 2023 through 2025 2Consists of R&D, SG&A, Amortization of Acquired Intangible Assets 3We expect to reach net operating cash flow positivity by 2025

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![](castlebiosciencesq42022-015.jpg)

15 Q3 2022 Operating Expenses Executed planned investments to support our growth initiatives for long-term value creation Operating Expense by Quarter1 1Amounts in millions. Operating expenses rounded and summarized as presented Key Drivers for Q3 2022 OpEx • Cost of Sales – Higher personnel costs due to headcount additions, particularly in our laboratories related to recent acquisitions. Higher laboratory activity, which is attributable to higher test volumes, also increased costs of supplies and services. • R&D – Higher personnel costs associated with our increased headcount to manage and run our clinical studies, which include expenses related to salaries, wages and stock-based compensation as well as higher inventory usage to support R&D activities and higher costs for clinical studies. • SG&A – Higher personnel costs associated with headcount expansion in our dermatology, GI and mental health commercial teams, which include expenses related to salaries, stock-based compensation and bonuses. • Amortization of Acquired Intangible Assets – Related to MyPath Melanoma, TissueCypher and IDgenetix tests.

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![](castlebiosciencesq42022-016.jpg)

16 Presented three-year financial targets and strategic guideposts at 2022 Investor Day AGA Clinical Practice Update released with best practice advice for the potential utilization of TissueCypher to risk stratify patients with non-dysplastic Barrett's esophagus Key Q3 and Recent 2022 Accomplishments Received AZBio Fast Lane Award from the Arizona Bioindustry Association (AZBio), recognizing Castle's achievement of outstanding milestones in the last 18 months Expanded evidence supporting Dermatology and Uveal Melanoma tests through the publication of four new peer-reviewed studies1 Achieved strong growth over Q3 2021 in total revenue (+58%) and achieved a new record in total test report volume (12,114, +57% compared to Q3 2021) 1Jarell et al. JAAD 2022 (DecisionDx-Melanoma); Ahmed et al. Cancer Medicine 2022 (DecisionDx-Melanoma); Williams et al. Melanoma Management 2022 (DecisionDx-UM); Hooper et al. Cancer Investigation 2022 (DecisionDx-SCC)

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![](castlebiosciencesq42022-017.jpg)

17 Expected publication of collaborative NCI study showing higher melanoma specific survival for patients tested with DecisionDx-Melanoma Expected finalization of Palmetto/Noridian LCD for DiffDx- Melanoma by end of Q2 2023; MyPath Melanoma is already covered by full reimbursement by Medicare Expect new GI and MyPath/DiffDx commercial team expansion to reach optimal productivity in Q2 2023 Expected closure of San Diego lab by end of 2022, folding operations into our Phoenix location Two-year TissueCypher ADLT rate beginning Jan. 1, 2023 Expected Upcoming Milestones

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![](castlebiosciencesq42022-018.jpg)

18 First-to-Market Dermatologic Franchise, Additional Growth Opportunities Diagnostic Support Risk Stratification Therapy Response1 1Target launch anticipated by the end of 2025 2New and unique ordering clinicians for all dermatologic tests combined between Oct. 1, 2021-Sept. 30, 2022 . Inflammatory Skin Disease Therapy Response Pipeline Strong provider growth and continued adoption with ~2,335 new ordering clinicians and ~9,155 unique ordering clinicians for our dermatologic tests over the last 12 months2

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![](castlebiosciencesq42022-019.jpg)

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![](castlebiosciencesq42022-020.jpg)

20 Traditional Approaches to Staging Melanoma Miss Patients with Aggressive Tumor Biology \*Excludes stage IV AJCCv7 J Clin Oncol 2009. SEER data release 2017. Ibrahim et al. Ann Surg Oncol 2020.

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![](castlebiosciencesq42022-021.jpg)

21 DecisionDx- Melanoma Class Result Breslow Thickness Ulceration Mitotic Rate Age Breslow Thickness Ulceration Mitotic Rate SLN Status Age Tumor Location Individual Risk of Sentinel Lymph Node Positivity Individual Risk of Recurrence Whitman et al. JCO PO 2021; Jarell et al. JAAD 2022 Neural network with AI algorithm DecisionDx-Melanoma Provides Answers for Two Critical Clinical Questions DecisionDx-Melanoma test report DecisionDx-Melanoma test results predict a patient's individual risk of recurrence and individual risk of sentinel lymph node positivity using two proprietary algorithms

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![](castlebiosciencesq42022-022.jpg)

22 DecisionDx-Melanoma GEP Has Consistent and Independent Evidence of Prognostic Value across Studies Greenhaw et al. JAAD 2020 1086420 100 80 60 40 20 0 Time (Years) % R e cu rr e n ce F re e 1086420 100 80 60 40 20 0 Time (Years) % D is ta n t M e ta st as is F re e RFS DMFS Breslow thickness (per mm) 1.12 (1.03-1.22), p=0.01 1.14 (1.02-1.26), p=0.02 Ulceration 1.63 (1.18-2.25), p=0.003 2.03 (1.48-2.78), p<0.001 Age (per year) 1.01 (0.99-1.03), p=0.60 1.00 (0.98-1.03), p=0.65 SLNB 2.42 (1.88-3.10), p<0.001 2.80 (2.07-3.77), p<0.001 31-GEP test 2.90 (2.01-4.19), p<0.001 2.75 (1.76-4.32), p<0.001) FEATURE HR RFS (95% CI) p-value HR DMFS (95% CI) p-value Class 1A Lowest Risk Class 1B/2A Increased Risk Class 2B Highest Risk • Quantifies expression of 31 genes from primary tumor using RT-PCR • Applies validated algorithm 31-GEP class result remains a consistent component of all DecisionDx-Melanoma reports

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![](castlebiosciencesq42022-023.jpg)

Collaboration with the National Cancer Institute Linking DecisionDx-Melanoma clinical testing with patients captured in the NCI-SEER Registry

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![](castlebiosciencesq42022-024.jpg)

24 NCI/SEER Data Linked with DecisionDx-Melanoma Test Results Data analysis of a cohort of real-world, unselected, prospectively tested patients with cutaneous melanoma 31-GEP Tested 93.1% (92.0-94.2%) 4.8% (174/3,621) Matched Untested 91.2% (90.4-91.9%) 6.1% (658/10,863) Hazard Ratio‡ 0.79 (0.67-0.93) P=0.006 3-year OS (95% CI) Deaths, % (n/N) Benefit in Overall Survival (OS) in patients who were tested at 3 years over those who were not tested 31-GEP Tested 97.7% (97-98.4%) 1.6% (58/3,621) Matched Untested 96.6% (96.2-97.1%) 2.2% (238/10,863) Hazard Ratio‡ 0.73 (0.54-0.97) P=0.03 3-year MSS (95% CI) Deaths, % (n/N) Benefit in Melanoma Specific Survival (MSS) in patients who were tested at 3 years over those who were not tested 21% 27% Kurley et al. Presented at European Association of Dermoto Oncology (EADO) conference in Seville, Spain; April 21-23, 2022 ‡Hazard ratio (HR) was computed using the untested patients as referenced for 31-GEP tested cohort. A HR less than 1.0 demonstrates improved survival in 31-GEP tested patients. Diagnosis date 2016 and onward. Data provides direct evidence that patients tested with DecisionDx-Melanoma have better survival rates than untested patients and suggests that testing can aid in risk-aligned treatment plans for improved patient outcomes and survival rates

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![](castlebiosciencesq42022-025.jpg)

25 DecisionDx-Melanoma Disease Specific Survival Outcomes are Favorable Relative to Other Tests MSS mortality difference of 1.1% at 3 years when comparing tested and untested populations Sentinel lymph node biopsy (SLNB) • SLNB is a risk-stratification surgical procedure "test" in melanoma • MSLT-1 found that SLNB had no impact on 10-year melanoma-specific survival1 Tumor size P-value 10-yr MSS Thin (<1.2mm) Not reported Not impacted Intermediate (1.2-3.5mm) not significant (p=.18) Not impacted Thick (>3.5) not significant (p=.56) Not impacted BCSS mortality difference of 0.50% at 3 years when comparing tested and untested populations Breast Cancer Test2 3-yr BCSS\* Breast Cancer Test 99.6% Matched Untested 99.1% Absolute Mortality Difference 0.50% (p<0.05) . 3-yr MSS3 DecisionDx-Melanoma 97.7% Matched Untested 96.6% Absolute Mortality Difference 1.1% (p<0.05) Breast Cancer Test 1Morton et al. N Engl J Med 2014; 2Zhang et al. Breast Cancer Res Treat. 2020; 3Kurley et al. EADO 2022. \*https://apps.automeris.io/wpd/

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26 Patients with Melanoma Desire Testing with DecisionDx-Melanoma 90% Ahmed et al. Cancer Medicine 2022; some values have been rounded None of the patients surveyed indicated decision regret regarding their decision to obtain DecisionDx -Melanoma testing, even patients who received a poor prognosis/high-risk (Class 2) DecisionDx-Melanoma test result Wanted prognostic information about their melanoma tumors at diagnosis 92% Felt the testing was useful 77% Wanted testing to obtain all of the information they could about their melanoma 54% Of the patients who did not receive 31-GEP testing, 54% wished they had been offered the option Data from a patient study conducted in collaboration with the Melanoma Research Foundation

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27 DecisionDx-Melanoma Is Supported by Significant Scientific Evidence 9,000+ Total patients included in studies including independent validation 36+ Peer-reviewed, published studies including prospective studies and 2 meta-analyses 112,820+ Patients with a clinical DecisionDx-Melanoma order from 10,750+ clinicians 1A Level 1A evidence\* 50% Demonstrated change in management for 1 of 2 patients tested Medicare+ Covered by Medicare and multiple private insurers with an industry-leading patient assistance program \*According to sort system, used by American Academy of Dermatology Following a diagnosis of cutaneous melanoma, providers make two important treatment decisions – whether to recommend SLNB and what type/frequency of follow up should be used. Data as of Sept. 30, 2022

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29 Cutaneous Squamous Cell Carcinoma Is an Emerging Problem in the U.S. • Managing SCC is a significant clinical issue as deaths from SCC are now estimated to exceed those from melanoma • Because cancer treatment plans and their outcomes are guided by risk for metastasis, prognostic accuracy has direct implications on patient management • Traditional staging fails to identify >30% of SCC cases who go on to metastasize, and >75% of SCC cases are over-called by staging • Unlike melanoma, breast and other common cancers, SCC patient care has not been personalized with risk predicting gene expression profile (GEP) tests SEER data release 2019; Mansouri et al. JAMA Dermatol 2017; https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/ Utility of traditional clinicopathologic risk factors is limited by their low positive predictive value 2, 0000 ~7,650 DEATHS PER YEAR IN THE U.S. 4,000 6,000 8,000 10,000 12,000 14,000 16,000 >15,000 Melanoma SCC

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30 How is Risk Assessment Traditionally Done for SCC Patients? • The SCC community uses the term "high-risk" SCC to describe different patient populations • Current SCC staging fails to identify >30% of cases who will go on to experience metastasis Additional Risk Factors from NCCN and Mohs AUC: Rapidly growing tumor, neurologic symptoms, LVI, site of prior RT or chronic inflammatory process, and select histologic subtypes (also see template for SCC testing criteria) NCCN1 HR or Mohs AUC2 >2 cm3, Deep3 (broad definition), PNI3 (broad def'), Poorly differentiated3, LVI5 Ear, Lip, Temple3 Scalp6 Immunocompromised3 BWH4 T2a Any 1 of: >2 cm, Deep (>SC fat), PNI (≥0.1mm), Poorly diff' BWH4 T2b Any 2-3 of: >2 cm, Deep (>SC fat), PNI (≥0.1mm), Poorly diff' "HIGH RISK"Broader Criteria Narrower Criteria Higher PPV 1 NCCN Guidelines for Squamous Cell Skin Cancer v2.2022; 2 Connolly et al. JAAD 2012; 3 Thompson et al. JAMA Derm 2016; 4 Jambusaria-Pahlajani et al. JAMA Derm 2013; 5 Skulsky et al. Head & Neck 2016; 6 Mo et al. JAMA Derm 2020

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31 DecisionDx-SCC Predicts Metastatic Risk For SCC Patients With One Or More Risk Factors Wysong et al. JAAD 2021; Ibrahim et al. Future Oncology 2021 Class 1: Low Biological Risk Less than half the general study population risk • Quantifies expression of 40 genes from primary tumor using RT-PCR • Applies a validated neural network algorithm • Accurately classifies patients as low, moderate or high biological risk Class 2A: Moderate Biological Risk Similar to the strongest traditional factors SCC patients with one or more risk factors Class 2B: High Biological Risk ≥50% risk of metastasis

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32 Decisiondx-scc Is Validated To Predict Metastatic Risk For Individual SCC Patients With One Or More Risk Factors Wysong et al. JAAD 2021; Ibrahim et al. Future Oncology 2021 M e ta st a si s- fr e e s u rv iv a l (M F S) Years n = 420 p < 0.0001 Cohort Distribution: Class 1 Class 2A Class 2B Kaplan-Meier Estimated MFS Class 1 – Low Biological Risk <7% risk of metastasis; Less than half the general study population risk Class 2A – Moderate Biological Risk 20% risk of metastasis; Similar to the strongest traditional factors Class 2B – High Biological Risk ≥50% risk of metastasis

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34 A clinical hurdle for dermatopathology is the accurate diagnosis of difficult-to-diagnose melanocytic neoplasms Unmet Need in Patients with a Difficult-to-Diagnose Pigmented Lesion Of the estimated two million suspicious pigmented lesions biopsied annually in the U.S., approximately 300,000 of those cannot be classified with confidence as either benign tissue or melanoma through traditional histopathology methods These difficult-to-diagnose lesions are commonly sent for second opinions to expert dermatopathologists who have more experience with challenging cases; however, the nature of many lesions remains ambiguous with discordant rates of lesions in this category of 25-43% (Elmore et al. 2017) Diagnostic ambiguity can lead to clinical management uncertainty and overtreatment, leading to unnecessary excisions and increased patient morbidity, and undertreatment, with the potential for missing diagnoses of malignant melanoma The Clinical Problem

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35 Diagnostic GEP is Designed to Provide Clinically Actionable, Objective Results for Nearly All Patients Benign Intermediate or Technical Failure (1.3%) Malignant Benign Intermediate or Technical Failure (22.2%) Malignant By leveraging our second GEP test, >98% of patients with ambiguous melanocytic lesions received a clinically actionable result1,2>98% 1Goldberg et al. SKIN 2021: s792; 2Both tests can be ordered independently. Unless DiffDx-Melanoma is specifically requested, we run MyPath first. If the case results in an intermediate result or fails to produce a result, DiffDx-Melanoma will be run second to provide additional diagnostic clarity.

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37 - 100,000 200,000 300,000 400,000 HGD (10%) LGD (0.26%) IND (1.5%) NDBE (0.80%) LGD (1.7 63 Need for additional risk stratification tools 435,000 Barrett's Esophagus Related Endoscopies Per Year Expert Pathology NDBE=Non-dysplastic Barrett's esophagus; IND=indefinite for dysplasia; LGD=low-grade dysplasia; HGD=high-grade dysplasia 1Progression rates: Rastogi et al. Gastrointest Endosc 2008; Krisnamoorthi et al. Gastrointest Endosc 2020; Singh et al. Gastrointest Endosc 2014; Wani et al. Clin Gastroenterol Hepatol 2011; 2Curvers et al. Am J Gastroenterol 2010; 3Duits et al. Gut 2015; 4Visrodia et al. Gastroenterology 2016. 50% 50% of annual progressors are initially diagnosed as non-dysplastic1 85% Up to 85% of low-grade patients are downgraded upon expert GI pathology review2,3 25% 25% of high-grade/cancer diagnoses occur within 1 year of endoscopy4 P at h o lo gy (% p ro g re ss io n /y e a r) Endoscopies

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38 Molecular biomarkers to detect changes in the context of tissue structure prior to morphologic changes Biomarkers and Spatial Biology Vision systems that objectively and reproducibly analyze and interpret tissue structures and features Digital Microscopy Peer-reviewed publications that demonstrate the effectiveness of the test Clinical Validation A risk classifier trained on a large data set to recognize progressor vs non-progressor tissue samples Artificial Intelligence TissueCypher is a Risk Stratification Tool for Patients with Barrett's Esophagus

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39 The World's First Prognostic AI-driven Precision Medicine Test for Barrett's Esophagus Low RiskHigh Risk • Indicated for NDBE, IND, and LGD • High Risk score enables increased surveillance or early intervention to prevent cancer • Low Risk score minimizes over treatment and supports extension of surveillance intervals to guideline recommendations Individualize 5-year risk of progression to HGD or EAC

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40 TissueCypher Is the Strongest Independent Predictor of Progression HR = Hazard ratio. Pooled analysis completed by Castle Biosciences. 1Critchley-Thorne et al. Cancer Epidemiol Biomarkers Prev 2016; 2Critchley-Thorne et al. Cancer Epidemiol Biomarkers Prev 2017; 3Davison et al. Am J Gastroenterol 2020; 4Frei et. al. Clin Transl Gastroenterol 2020; 5 Frei et. al. Am J Gastroenterol 2021 n=699 patients1-5 (ND n=567, IND n=50, LGD n=82) 152 incident progressors, 38 prevalent cases, 509 non-progressors Original Pathologic Diagnosis HR = 7.7 (high- vs. low-risk) p<0.0001 HR = 2.8 (inter- vs. low-risk) p<0.0001 TissueCypher

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3–5-year surveillance3,4 1-year surveillance2 Endoscopic Eradication Therapy (EET) or 6–12- month surveillance2 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% Consideration of Patient Management Based on Risk of Progression 1Progression rates: Rastogi et al. Gastrointest Endosc 2008; Krisnamoorthi et al. Gastrointest Endosc 2020; Singh et al. Gastrointest Endosc 2014; Wani et al. Clin Gastroenterol Hepatol 2011. 2Consensus guidelines from ACG (2015), AGA (Medical Position Statement, 2011) and ASGE (2019); 3Shaheen et al. Am J Gastroenterol 2022 4Komanduri et al. Clin Gastroenterol Hepatol 2022. \*Data on file, Castle Biosciences. Data from pooled analysis of TissueCypher's risk stratification performance reported in five clinical validation studies. 5 -y e a r ri sk o f p ro g re ss io n Histology only NDBE1 IND1 LGD1NDBE (Low-Risk)\* NDBE (High-Risk)\* LGD/IND (High-Risk)\* LGD/IND (Low-Risk)\* High-Risk TissueCypherLow-Risk TissueCypher 41

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42EET = Endoscopic Eradication Therapy; PPI = Proton pump inhibitor 1Consensus guidelines from ACG (2015), AGA (Medical Position Statement, 2011) and ASGE (2019); 2Shaheen et al. Am J Gastroenterol 2022; 3Komanduri et al. Clin Gastroenterol Hepatol 2022 How Incorporation of TissueCypher Testing Can Change Clinical Practice NDBE IND LGD Surveillance in 3 to 5 years1,2,3 3 years if segment length ≥3 cm2 5 years if segment length < 3 cm2 Surveillance in 3 to 6 months following PPI Rx, Surveillance in 12 months for persistent IND1,2 EET or Surveillance in 6-12 months1,2 Clinical guideline based on histology and segment length NDBE IND/LGD BE Consider surveillance in 3 to 5 years Consider surveillance in 12 months and PPIs as needed LOW Risk Class NDBE IND/LGD BE Rule out prevalent HGD/EAC and consider EET or surveillance in 1 year Rule out prevalent HGD/EAC and consider EET and PPIs as needed HIGH/INT Risk Class

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44 Medication Selection for Mental Illness Is Challenging ~53% of patients with major depressive disorder (MDD) have an inadequate response to first-line treatment1 Inadequate Therapy Response 72% of patients with MDD do not achieve remission using current standard of care treatment approaches2 Low Remission Rates The likelihood of discontinuation rises from 8.6% with first-line medication treatment to 41.4% with fourth-line treatment3 High Prevalence of Adverse Drug Events 1https://pubmed.ncbi.nlm.nih.gov/16390886/; 2https://pubmed.ncbi.nlm.nih.gov/16390886/ 3STAR\*D Trial Combined Across Four Medication Cycles "…finding an effective antidepressant can take years" - Mental Health America

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45 2.5x Increase in Remission Rates for Severe Depression Demonstrated Enhanced Clinical Outcomes vs. Standard of Care Control IDgenetix Response Rate ≥ 50% Reduction from Baseline Remission Rate Patients Achieving Remission p-value 0.05 0.02p-value 0.01 0.001 >2.5x increase in remission rate vs. control 2x increase in response rate vs. control Bradley et al. J Psychiatr Res 2018.

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46 IDgenetix PGx Original Trial & Error Multi-Gene Test RCT/Clinical Utility Medicare Coverage Comorbidity (MDD & Anxiety) Drug-Drug Interactions Lifestyle Factors IDgenetix is redefining the standards of next generation PGx Precision Medicine Designed to Streamline Medication Selection for Mental Health

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48 Strong Evidence Base • 24 peer-reviewed publications, 3,100+ patients Widespread Adoption • Nearly 8 in 10 patients diagnosed with uveal melanoma in the U.S. receive the DecisionDx-UM test as part of their diagnostic workup • 1,618 reports issued in 2021 Broad Reimbursement • In 2021, received payment on ~93% of claims • Medicare LCD covers patients with a confirmed diagnosis and no evidence of metastatic disease • 2022 Medicare rate of $7,776 AJCC and NCCN Guideline Inclusion DecisionDx-UM: the Standard of Care in the Management of Newly Diagnosed Uveal Melanoma ~2,000 patients diagnosed in the U.S. annually ~97% of patients – no evidence of metastatic disease at the time of diagnosis ~30% will develop metastases within 5 years Low-risk: ~67% Low Intensity Management High-risk: ~33% High Intensity Management Uveal Melanoma – A Rare Eye Cancer 15-Gene Expression Profile (GEP) Test Facts About Uveal Melanoma

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Thank you

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50 Use Of Non-GAAP Financial Measures (Unaudited) In this presentation, we use the metrics of Adjusted Revenue, Adjusted Gross Margin and Adjusted Operating Cash Flow, which are non-GAAP financial measures and are not calculated in accordance with generally accepted accounting principles in the United States (GAAP). Adjusted Revenue and Adjusted Gross Margin reflect adjustments to net revenues to exclude changes in variable consideration related to test reports delivered in previous periods. Adjusted Gross Margin further excludes acquisition-related intangible asset amortization. Adjusted Operating Cash Flow excludes the effects of repayments to Medicare of COVID-19 government relief advancements to healthcare providers. We use Adjusted Revenue, Adjusted Gross Margin and Adjusted Operating Cash Flow internally because we believe these metrics provide useful supplemental information in assessing our revenue and cash flow performance reported in accordance with GAAP, respectively. We believe Adjusted Revenue and Adjusted Gross Margin are also useful to investors because they provide additional information on current-period performance by removing the effects of revenue adjustments related to tests delivered in previous periods and, with respect to Adjusted Gross Margin, acquisition-related intangible asset amortization, which we believe may facilitate revenue and gross margin comparisons to historical periods. We believe Adjusted Operating Cash Flow is also useful to investors as a supplement to GAAP measures in the assessment of our cash flow performance by removing the effects of COVID-19 government relief payments, which we believe are not indicative of our ongoing operations. However, these non-GAAP financial measures may be different from non-GAAP financial measures used by other companies, even when the same or similarly titled terms are used to identify such measures, limiting their usefulness for comparative purposes. These non-GAAP financial measures are not meant to be considered in isolation or used as substitutes for net revenues, gross margin or net cash (used in) provided by operating activities reported in accordance with GAAP and should be considered in conjunction with our financial information presented on a GAAP basis and language from our earnings press release. Accordingly, investors should not place undue reliance on non-GAAP financial measures. Reconciliations of these non-GAAP financial measures to the most directly comparable GAAP financial measures are presented in the slides that follow. We are not providing a target for or a reconciliation of Adjusted Gross Margin, the most directly comparable GAAP measure, for 2025 because we are unable to predict certain items contained in the GAAP measure without unreasonable efforts.

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51 Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of adjusted revenue and adjusted gross margin, which are non-GAAP financial measures. See previous slide for further information regarding the Company's use of non-GAAP financial measures.

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52 Reconciliation of Non-GAAP Financial Measures (Unaudited) The table below presents the reconciliation of adjusted operating cash flow, which is a non-GAAP financial measure. See slide 47 for further information regarding the Company's use of non-GAAP financial measures.

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Appendix

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54 ESG Focus Areas for 2022 and Beyond Environmental policy Environmental metrics DEI statement DEI metrics DEI action plan/roadmap Vendor code of conduct/supplier standard In 2022, Castle Biosciences received a rating of AA (on a scale of AAA-CCC) in the MSCI ESG Ratings assessment.

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55 Employee Engagement is Part of our Core Strategy for Success Based on the results of Castle's annual employee survey1 Castle employee engagement score: 81% Healthcare benchmark average engagement score: 53% Response Rate 89% 1Data from June 2022 employee engagement survey administered by Energage 43% 40% 16% 1% Enthusiastically engaged Engaged Disengaged Deeply disengaged 40% 41% 17% 2% Enthusiastically engaged Engaged Disengaged Deeply disengaged Response Rate 86% 2 0 2 2 Healthcare benchmark response rate: 63% Castle employee engagement score: 83% Healthcare benchmark average engagement score: 66% 2 0 2 1 Healthcare benchmark response rate: 59%

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56 Commitment to Diversity ETHNICITY/RACE GENDER Data as of 8/1/22; Executive= Executive Director or Regional Business Director level and above TOTAL EMPLOYEES = 492 1.0% 7.1% 3.9% 11.2% 0.2% 3.0% 73.6% AMERICAN INDIAN OR ALASKA NATIVE ASIAN BLACK OR AFRICAN AMERCIAN HISPANIC NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER TWO OR MORE RACES (NOT HISPANIC OR LATINO) WHITE 3.2% 6.5% 3.2% 87.1% ASIAN HISPANIC TWO OR MORE RACES (NOT HISPANIC OR LATINO) WHITE 65.7% 34.3% FEMALE MALE EX EC U TI V ES A LL E M P LO Y EE S 35.5% 64.5% FEMALE MALE

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57 Award-Winning Company Committed to cultivating a culture of innovation, continuous growth and advancement 2019 Technology Innovation in Melanoma Award Winner

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58 Leadership Team Overview

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