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Adevture Island is divided into eight worlds. Each world has four stages, and each stage is divided into four sections, each of which is preceded by a small signpost in the ground. When you die, you will begin at the location of the last signpost that you passed.

Throughout each stage, Master Higgins (or Wonder Boy) will slowly lose vitality, represented by the vitality meter at the top of the screen. Higgins (or Wonder Boy) will lose one life if the vitality meter is allowed to deplete. The meter can only be refilled by collecting the various fruit that appear throughout the stage, which refill up to three bars of vitality, or by discovering milk, which will refill the meter completely.

Each world must be defeated sequentially, and there are no warp zones or secrets that will allow you to jump ahead and skip any of the worlds, which contributes to the games considerable difficulty.