Wario Land 4 (2001) served as the basis for the gameplay and level design. It was developed with GameMaker and features a cartoonish, high-resolution pixel art style inspired by SpongeBob SquarePants and French comics. Pizza Tower began as a role-playing video game with survival horror elements before evolving into a platformer inspired by Nintendo's dormant Wario Land series, to which McPig wanted to provide a spiritual successor.

The development began around March 2018 and was led by the pseudonymous designer McPig and programmer Sertif. Pizza Tower does not feature health or lives, and its difficulty depends on what the player chooses to achieve. At the end of each level, they activate an escape sequence and must return to the beginning within a time limit. Across 20 side-scrolling levels, the player increases their score by gathering collectibles and defeating enemies to build combos. It follows a pizza chef, Peppino Spaghetti, who must scale a tower to prevent the destruction of his pizzeria.

Pizza Tower is a 2023 platform game created by the indie developer Tour De Pizza.

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