In her hands is a book (traditionally Isaiah chapter 53) which she attempts to hold away from her son, the contents of which probably foretell his future sacrifice and his taking to himself the evil of the world.

Another similarity to relief sculpture is in the plain background: rather than the landscapes more common for exterior settings, Michelangelo has simply painted an expanse of sky.

He also eschewes the richly decorated throne typical of sacra conversazione altarpieces, and de-emphasises the angels' wings.

The black of the Virgin's robe was meant to be overpainted with the rich blue pigment, lapis lazuli, and the angels on the left are indicated only by the green underpaint used for flesh tones in a kind of non finito.

The completed angel nearest the Virgin is noted as being similar to a sketch the young Michelangelo made while he was apprenticed to Domenico Ghirlandaio.