Mafia initiation ritual details vary widely across accounts and regions

Evidence

Beyond these basic features the accounts contain a number of variations. The right index finger is most often the one that is pricked, but the thumb, the middle finger, and the lower lip are also alleged alternatives; a knife or the thorn of a bitter orange tree may replace the needle; in one description the image of the saint is replaced by the drawing of a skull, in another by a piece of scrap paper; in one instance the oath is taken not during the burning of the card but afterward, with the initiate holding the ashes. — Diego Gambetta, The Sicilian Mafia The Business of…, 379