Sicilian pizzaem is pizza prepared in a manner that originated in Sicily, Italy. Sicilian pizza is also known as sfincione (Italian:); Sicilian: sfinciuni or focaccia with toppings. This type of pizza became a popular dish in western Sicily by the mid-19th century and was the type of pizza usually consumed in Sicily until the 1860s. It eventually reached North America in a slightly altered form, with thicker crust and a rectangular shape. Traditional Sicilian pizza is often thick crusted and rectangular, but can also be round and similar to the Neapolitan pizza. It is often topped with onions, anchovies, tomatoes, herbs and strong cheese such as caciocavallo and toma. Other versions do not include cheese. The methods of making pizza are linked to local culture and country traditions, so there are differences in preparing pizza among the Sicilian regions of Palermo, Catania, Siracusa and Messina