Boil the pasta. Bring a large pot of salted water to a boil. Cook pasta until just shy of al dente. Reserve 1 cup of pasta water before draining.

Crisp the prosciutto. In a wide skillet, warm olive oil over medium heat. Add prosciutto ribbons and cook 2–3 minutes until edges curl and lightly crisp. Transfer to a plate. Leave any rendered fat in the pan.

Sauté aromatics. Lower heat slightly. Add butter, then garlic and sage. Cook 30–60 seconds until fragrant. Don’t let the garlic brown.

Build the sauce base. Whisk in pumpkin purée, then heavy cream. Stir until smooth. Add a pinch of nutmeg and red pepper flakes if using. Simmer gently for 2–3 minutes to thicken slightly.

Add Parmesan. Off heat, whisk in Parmesan until melted and silky. Season with salt and black pepper. Add a little lemon zest and a squeeze of juice to brighten.

Combine pasta and sauce. Add drained pasta to the skillet. Toss and splash in reserved pasta water, a little at a time, until the sauce coats the noodles and looks glossy.

Finish with prosciutto. Fold in half the prosciutto and keep the rest for topping. Taste and adjust seasoning. If it’s too thick, add more pasta water; if too thin, simmer 1 minute.

Serve. Plate with the remaining prosciutto on top. Add more Parmesan, a crack of pepper, and a few extra sage leaves if you like.