The Virgin Mary is surrounded by angels and seated on a throne covered with a richly patterned cloth. In the roundel above, Christ as ruler of the world imparts a blessing. It was the central panel of the high altarpiece, which also comprised four standing saints and a predella with scenes from the life of Saint Nicholas, commissioned by a member of the Quaratesi family for the church of S. Niccolò Oltrarno, Florence.

The saints are:

• St Mary Magdalene with an Annunciatory Angel in the roundel
• St Nicholas with St Francis in the roundel
• St John the Baptist with St Dominic in the roundel
• St George with the Virgin Annunciate in the roundel

St Nicholas' cope is decorated with embroidered scenes from the early life of Christ:

• The Nativity
• The Adoration of the Magi
• The flight into Egypt
• The Massacre of the Innocents
• The Presentation in the Temple
• The Baptism of Christ

The Virgin is seated on a stone throne. Jesus is eating grapes, a eucharistic symbol. Two angels with lutes are seated at the base of the throne (the bottom edge has been cut), and two kneel beside the throne, set slightly back. It was the centre of an altarpiece commissioned in 1426 by the notary Ser Giuliano degli Scarsi for the chapel of St Julian in S. Maria del Carmine, Pisa.

Giorgio Vasari described it in 1568 as showing Saints Peter, John the Baptist, Julian and Nicholas on either side of the Virgin and Child. He also wrote that the predella had the Adoration of the Magi at its centre, with paired scenes from the lives of the Saints shown above on either side. These are:

• St Julian killing his wife with St Nicholas dowering the Three Daughters
• The Crucifixion of St Peter with The Beheading of St John the Baptist

According to Vasari, several saints surrounded a panel of The Crucifixion in the upper tier. They included St Paul and St Andrew.
Small panels with St Augustine, St Jerome and unidentifed Carmelite Saints come from the pilasters. The other two Doctors of the Church, Gregory and Ambrose, are now missing.