Idol Janshi Suchi-Pai II is a strip mahjong game featuring seven opponents in eight stages (the final boss, having two costumes). The player's character is Suchi-Pai. At the start of the game, the player selects their first opponent out of the other "Mahjong Pies." The remaining "Pies" are played in a random sequence before moving on to the final three stages, all played in order.

As in the original game, stages are completed by removing all the tiles from a matching game played between rounds of mahjong, or by completely wiping out an opponents betting funds. Once a girl is defeated, the player is shown that girls strip sequence.

Matching tiles in the matching game reward the player with bonus items that are used to cheat during following hands of mahjong. Some tiles are used to fill up a meter instead of giving an item. Once the meter is full, a revealing animated sequence is played of a defeated "Mahjong Pie," who then joins Suchi-Pai in assisting the player.

If the player loses all of their betting funds, then the game is over.