In Adventure Island II the player takes the role of Master Higgins who has to save his cavegirl from aliens which also want to dominate the Earth. The basic gameplay elements are the same as in its predecessor Adventure Island: Master Higgins walks through the levels while fighting against various enemies. One hit results in his untimely death unless he carries one of the various power ups, e.g. weapons or a skateboard which improves his speed. He also needs to collect food to fill up his steadily decreasing starvation bar - death awaits if it hits zero.

A big addition are dinosaurs which serve as mount and offer different abilities, e.g. flying or shooting fireballs. Like all power ups these don't have to be used instantly but can be saved for later: before every level the player can choose the power ups he wants to bring with him. There are overall eight worlds with different themes which are represented by a overhead map. Sometimes there are different paths with other level and at the end of a world Master Higgins has to fight a boss.