Sarzana Cathedral was built on the site of the former pieve of San Basilio and was under construction from 1204 to 1474, when the upper part of the west front was completed by Leonardo Riccomanni of Pietrasanta. In 1735 three statues of popes were added to the top of the façade: Saint Eutychianus in the centre between Pope Sergius IV and Pope Nicholas V.
The church is in a Romanesque-Gothic style. It has a west front of white marble, featuring a portal with a small Gothic rose window above it, between two side blocks of the 17th century. To the south is the battlemented campanile, the sole remnant of the ancient Pieve di San Basilio. The ground plan is in the form of a Latin cross. The nave is divided into three aisles by two arcades of widely spaced polygonal columns supporting high arches. The central nave terminates in the choir and the apse, and the side aisles each terminate in a chapel; all three are roofed by cupolas. To either side of the nave is a row of four side chapels, added in the late 17th century. Each wing of the short transept also contains a chapel. The wooden panelled ceiling was carved by Pietro Giambelli between 1662 and 1670.
The cathedral contains a famous relic of St Andrew and of the Blood of Christ, which is preserved in the Chapel of the Most Precious Blood (Cappella del preziosissimo sangue) to the south of the choir and high altar.
Sarzana Cathedral is also known as the location of the oldest known painted Italian crucifix, the Cross of Maestro Guglielmo, dated 1138, a central work of Romanesque painting, despite some re-touching of the face and body in the 14th century. The crucifix is a prime example of the iconography of the Christus triumphans that preceded the establishment of the iconography of the Christus patiens, which represents a more human and suffering Jesus. The crucifix is in the Chapel of the Cross to the north of the choir and high altar.
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