The silver-gilt medallions on both sides of this exceptionally handsome processional cross, which is finely wrought in silver and silver gilt, make it unique among surviving Byzantine examples. On the face of the cross, at the center, is a medallion with a bust of the blessing of Christ, surrounded by an incised pattern of freely worked repoussý rinceau vine scrolls on each of the four arms, which together form a smaller cross. At the ends of the crossbar are medallions with images of the Virgin and of John the Precursor (the Baptist) raising their hands in prayer toward the image of Christ-the standard Deesis composition in the Byzantine world. At the terminals of the vertical arm of the cross are the archangels Michael and Gabriel, respectively, each dressed in a different Byzantine court costume. An elegant acanthus leaf decorates the gilded foot of the cross, at the point where the staff by which the cross was carried was inserted. A ruched, ribbonlike band outlines the cross.

The reverse is severely plain except for the five silver-gilt medallions: at the center is Saint Thalelaios, a medical saint martyred in the late third century, who carries the medical case and lancet of his profession; he is flanked by the popular Byzantine saints Nicholas and John Chrysostom. At the ends of the vertical arm of the cross are the archangels Uriel (above) and Raphael (below), again in Byzantine court dress. The silver-gilt base is inscribed in Greek, 'Supplication [gift] of Leo, Bishop,' and an inscription identifies each of the figures on the cross, as well.

The donor of the cross cannot yet be connected with a historical figure. In style, however, the work is similar to a group of processional crosses made between the eleventh and thirteenth centuries, which have medallions on the front and niello decoration on their reverse sides. The freely wrought rinceau pattern and the elegant articulation of the figures on this example identify it as among the earliest in the series; it probably dates from sometime between the early and mid-eleventh century. It is argued that these crosses were meant as votive offerings to the central image on the reverse side. Since Saint Thalelaios, though now little known, was widely popular in the Byzantine world, the site of the consecration of this cross and even that of its manufacture remain uncertain. It may have been dedicated to a site named for the saint, or it may have been meant as a general gift of thanksgiving for a cure and not associated with a place that bore a specific connection to him. It has been suggested that as the saint is named in the liturgy for the blessing of the waters at Epiphany (January 6), the cross may have been meant for use in that rite.

The Museum's cross was constructed of eight hammered silver sheaths, which were held together at the ends of the crossarm by eight ball-shaped finials. The medallions decorating the cross were first filled with gypsum and backed with iron disks, which were soldered on for additional support before the sheaths were attached to the core with the same solder. The separately modeled central medallions covered the ends of the sheaths. The burnished silver and partially gilded surfaces of the cross are well preserved, and portions of the iron core survive, but only two of the finials are complete.