The upper section shows Christ on the cross, a skull at its foot. Beneath his arms are two flying angels and the Virgin and Saint John sit on the rocky ground at either side of him. In the richly tooled band below the Virgin and Child are shown on a gothic throne, surrounded by eight saints: in the upper row, left to right, Saints Nicholas of Bari (with three golden balls), Lucy (with a flaming lamp), Dorothy (with flowers and apples) and Bartholomew (with flaying knife), in the lower row Catherine (with wheel), John the Baptist (with scroll 'Ecce Agnus Dei, qui tollit pecata mundi'), Paul (with sword) and Margaret (with a dragon). In the predella are three quatrefoils, depicting Christ blessing, flanked by Gabriel and the Virgin Annunciate.

When purchased, this painting was thought to be by Andrea di Cione, called Orcagna. Prince Albert paired it with a Fra Angelico, Madonna of Humility (now attributed to Zenobi Strozzi, RCIN 400039), in his Writing Room at Osborne, where it appears in James Robert's watercolour of 1851 (RCIN 926224). It is now thought to be by the (still anonymous) artist who painted the altarpiece known as the 'Madonna della Misericordia’ (‘The Virgin of Mercy’), in the Accademia, Florence. The predella is clearly alien to the main panel; it differs in thickness, grain and technique, and may be the work of a younger artist, c.1400.