Your girlfriend is once again kidnapped by aliens, and you have to rescue her, forcing your way through various levels.
The gameplay and the design haven’t much changed since Adventure Island II: there is a world map, you can choose items before starting a level, the levels themselves are quite short (unlike Adventure Island, where each large level contained several stages).
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You perform standard “adventure island” activities: ride various types of dinosaurs, throw boomerangs at snails, birds, snakes, and skulls, collect grapes and apples, jump over stones, and of course, ride your old trusty skateboard.
The player takes the role of Master Higgins, a tropical villager who tries to save his girlfriend from an evil witch doctor (returning from the first game) who has kidnapped her. He has taken Tina and a number of women to several islands, where they are guarded by his monster minions. To aid him he has a skateboard, a variety of dinosaur helpers and an assortment of weapons.
After some naming confusion with the ending in the first game, the sequel makes it clear that Princess Leilani – the damsel in distress from the first game – and Tina – Master Higgins’ frequently kidnapped girlfriend who is mentioned by name towards the end of the first game – are separate people: in fact, they’re sisters.