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A number of specimens exist of Pisanello's medal of John; most of these are bronze or lead casts. Renaissance medals were often produced in a variety of metals, sometimes with a few gold or silver ones.  The bronze example in the British Museum measures 10.3 centimetres in diameter. The obverse of the work portrays a bust of the emperor looking to the right. His hair hangs in corkscrew curls and he sports a moustache and pointed beard. The emperor's back is curved, giving the suggestion of a slight stoop. He is dressed in a high-necked shirt with an open jacket, with discernible buttons on both garments. The most striking aspect of the portrait is the emperor's hat: this large garment occupies around half the pictorial space of the obverse. The hat is sharply peaked and its crown is tall, domed and vertically ribbed. Extravagant hats were typical of Byzantine officialdom and many were drawn by Pisanello. At the summit of the hat is a jewel which intrudes into the space of the Greek inscription encircling the portrait. The inscription reads: +ἸΩÁΝΝΗC • BACIΛEV̀C • KAÌ • ἈVTOKPÁTΩP • ῬΩMÁIΩN • Ὁ • ΠAΛΑIOΛÓΓΟC (‘John, emperor and autocrat of the Romans, the Palaeologus’).  This style of hat is similar to that which had often been used to represent Mongols in earlier European painting.
Unlike some of Pisanello's other portrait medals, such as those of Leonello d'Este, the reverse of the medal of John presents no iconographic or allegorical mysteries. It shows the emperor on horseback, in profile to the right. Behind him, mounted on another horse, is a page or squire viewed from the rear and foreshortened. The emperor wears his distinctive hat and carries a bow on his left side and a quiver of arrows above his right leg. The double reins of the emperor's horse are visible and both horses possess elaborate straps over their hindquarters. The illustration conveys the arrest of a hunting expedition occasioned by John's encounter with a pedestalled wayside cross. The gesture of the emperor's raised right hand indicates his acknowledgement, in an act of piety, of the cross before him. The event takes place in a rocky landscape and is framed in the bottom portion by a Greek inscription: ἜPΓON • TÔV • ΠICÁNOV • ZΩΓPÁΦOV (‘The work of Pisano the painter’). This inscription is repeated in Latin within the top of the scene: OPVS • PISANI • PICTORIS.
were typical of Byzantine officialdom wayside cross often been used to represent British Museum obverse right Mongols Mongol Pisanello left medal