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In the early 1930s, brothers Pasquale ‘Pat’ and Harry Olivieri owned a hot dog stand in Philadelphia and, on one occasion, decided to make a sandwich for lunch using chopped beef and grilled onions.

While Pat was eating the sandwich, a cab driver stopped by and was interested in it, so he requested one for himself. After eating it, the cab driver suggested that they quit making hot dogs and instead focus on the new sandwich.

They began selling this variation of steak sandwiches at their hot dog stand near south Philadelphia's Italian Market. They became so popular that Pat opened up his own restaurant which still operates today as Pat's King of Steaks. The sandwich was originally prepared without cheese; Pat claimed provolone cheese was first added by Joe "Cocky Joe" Lorenza, a manager at the Ridge Avenue location, in the 40s.

The meat traditionally used is thinly sliced rib-eye or top round, although other cuts of beef are also used. The steak slices are quickly browned on a lightly oiled griddle, and then scrambled into smaller pieces with a flat spatula. Slices of cheese are placed over the meat, letting it melt, and then the Amoroso or Vilotti-Pisanelli bread roll is placed on top of the cheese. The mixture is then scooped up with a spatula, pressed into the roll, and cut in half. Common additions include sautéed onions, bell peppers, mushrooms, mayonnaise, hot sauce, salt, pepper and ketchup.

Cheesesteaks have become popular in restaurants, cafeterias and food carts throughout the city with many locations being independently owned, family-run businesses, and several fast food chains.