Rare rock paintings and hand stencils from northwest China’s northern Xinjiang Uyghur Autonomous Region, thought to possibly date to the Pleistocene, are described and analysed in terms of subject matter, possible age, relationship to other forms of rock art and location. We highlight three sites in particular that have a range of naturalistic animal and some human-like depictions, near the city of Altay (also known as Aletai, Altai). What have been interpreted as the earliest depictions of people on skis focus discussion, along with the potential age of the rock art. Direct dating was not possible but it is concluded from indirect methods that the naturalistic-looking animal and human paintings, and the stencils, were most likely made between 4000 to 5250 years ago. The contemporary significance of the rock art imagery and sites is reviewed along with aspects of conservation and management. It is concluded that there are many reasons some of the imagery appears to us to resemble naturalistic depictions at sites in Europe, other areas of China, the larger Altay region and Southeast Asia. These include aspects of hunter-gatherer lifestyle that depends on animals for survival, a shared human visual brain and our own forms of seeing and interpreting. Thus we caution that what to us appears as a ‘naturalistic style’ should not be used as evidence of a particular age or direct relatedness between dispersed cultural groups.