A few single-nucleotide polymorphisms (SNPs) have been identified to be associated with cutaneous melanoma (CM) survival through genome-wide association studies, but stringent multiple testing corrections required for the hypothesis-free testing may have masked some true associations. Using a hypothesis-driven analysis approach, we sought to evaluate associations between SNPs in ketone body metabolic pathway genes and CM survival. We comprehensively assessed associations between 4196 (538 genotyped and 3658 imputed) common SNPs in 44 ketone body metabolic pathway genes and CM survival, using a dataset of 858 patients of a casecontrol study from The University of Texas M.D. Anderson Cancer Center as the discovery set and another dataset of 409 patients from the Nurses' Health Study and the Health Professionals Follow-up Study as the replication set. There were 95/858 (11.1%) and 48/409 (11.7%) patients who died of CM, respectively. We identified two independent SNPs (ie, PDSS1 rs12254548 G>C and SLC16A6 rs71387392 G>A) that were associated with CM survival, with allelic hazards ratios of 0.58 (95% confidence interval [CI] = 0.44-0.76, P = 9.00 × 10 −5 ) and 1.98 (95% CI = 1.34-2.94, P = 6.30 × 10 −4 ), respectively. Additionally, associations between genotypes of the SNPs and messenger RNA expression levels of their Abbreviations: CI, confidence interval; CM, cutaneous melanoma; CMSS, cutaneous melanoma-specific survival; GWAS, genome-wide association study; HPFS, The Health Professionals Follow-up Study; HR adj , adjusted hazards ratio; LD, linkage disequilibrium; MDACC, The University of Texas MD Anderson Cancer Center; NHS, The Nurses' Health Study; PDSS1, decaprenyl diphosphate synthase subunit 1; SLC16A6, solute carrier family 16 member 6; SNP, single-nucleotide polymorphism. d BFDP was used for multiple test correction with detected a highest hazard ratio of 2.0 and a prior probability of 0.1. e Adjusted for age and sex in an additive genetic model. f Meta-analysis in a fix-effects model. Abbreviations: BFDP, Bayesian false-discovery probability; CI, confidence interval; EAF, effect allele frequency; GWAS, genome-wide association study; HPFS, Health Professionals Follow-up Study; HR, hazards ratio; MDACC, The University of Texas MD Anderson Cancer Center; NHS, Nurses' Health Study; P het , P value for heterogeneity by Cochrane's Q test; PDSS1, decaprenyl diphosphate synthase subunit 1; SLC16A6, solute carrier family 16 member 6; SNP, single-nucleotide polymorphism. 644 | DAI ET AL.