Court artists working for the German and Sicilian emperor Frederick II Hohenstaufen (1194–1250) excelled in the creation of exquisite cameos. Here a rare image of a saint depicts an episode from the infancy of Saint Nicholas, in which he refuses his mother's milk. Seated frontally and wearing a long tunic, she attempts to pull her nude son, who is seated sideways, toward her exposed breast. He refuses by grasping her hand. The theme is one known primarily in a monastic context, where it served as an exemplum for fasting and for abstinence.

The pendant must have had a personal significance for the owner, perhaps named Nicholas; whether the wearer was an ecclesiastic or a court figure is uncertain. As the relics of Saint Nicholas had resided at Bari, in Apulia, since the eleventh century, the protection of this important saint would have had wide appeal in Italy. Carved in a bold but precise hard-stone style, this is a rare and unrecorded cameo among the works produced in southern Italy during the remarkable reign of Frederick II, who revived antique traditions as part of his court culture.