According to legend, "Death" appears at midnight every year on Halloween. Death calls forth the dead from their graves to dance for him while he plays his fiddle (here represented by a solo violin). His skeletons dance for him until the rooster crows at dawn, when they must return to their graves until the next year. The piece opens with a harp playing a single note, D, twelve times (the twelve strokes of midnight) which is accompanied by soft chords from the string section. The solo violin enters playing the tritone consisting of an A and an E-flat—in an example of scordatura tuning, the violinist's E string has actually been tuned down to an E-flat to create the dissonant tritone. The first theme is heard on a solo flute, followed by the second theme, a descending scale on the solo violin which is accompanied by soft chords from the string section. The first and second themes, or fragments of them, are then heard throughout the various sections of the orchestra. The piece becomes more energetic and at its midpoint, right after a contrapuntal section based on the second theme, there is a direct quote played by the woodwinds of the Dies Irae, a Gregorian chant from the Requiem that is melodically related to the work's second theme. The Dies Irae is presented unusually in a major key. After this section the piece returns to the first and second themes and climaxes with the full orchestra playing very strong dynamics. Then there is an abrupt break in the texture and the coda represents the dawn breaking (a cockerel's crow, played by the oboe) and the skeletons returning to their graves.
Jeffery Hatcher's theatrical production of The Turn of the Screw incorporates "Danse Macabre" in a scene as a way to increase tension and uneasiness. The actor playing Miles must hum or sing the piece over a monologue which is spoken by the Governess.
The "rock orchestra", Esperanto, titled their third album Dance Macabre, and its final track included a version of Saint-Saëns' piece.
It was also used for the 2011 BBC Proms by Horrible Histories, to illustrate the level of death during the Middle Ages in Britain.
2010 Olympic figure skating champion Kim Yuna used Danse Macabre as the music for her short program for the 2008–2009 season. At the World Championships, Kim achieved a world record score for the program, and went on to place first at the event.
In the RPG Maker VX game, Cloé's Requiem, Danse Macabre is used for the background music when Michel loses all of his health.