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Itoh is first seen in the Plantation's storeroom after Quote has finished scaling the Outer Wall. Thinking that Quote is one of the killer robots that the Doctor was warning the Mimiga about, Itoh immediately begins begging not to be killed. When he realizes that Quote isn't there to hurt him, he calms down and explains that he was one of the humans who came to the island to study it, but was transformed by Misery's magic. Though he's a great engineer and could probably escape, he has a great fear of heights and doesn't want to attempt climbing down the Outer Wall, leaving him stuck hiding in the storeroom.
While helping Momorin Sakamoto construct her rocket, she asks Quote to find Itoh to help her. Itoh expresses surprise when he finds out that Momorin is still alive and gives Quote the Controller she'll need to complete the rocket. After Quote delivers the controller, Itoh decides to stop hiding and helps Momorin finish the rocket while Quote rests before the final battle.
After the Doctor is defeated, Itoh escapes with the others on the helicopter. Together with the Sakamotos, he constructs a machine to transform himself and Sue back into humans. Although the machine seems to work, they both sneeze after a couple seconds and turn back into Mimigas. It's unknown whether or not they ever successfully turn back.
|Cave Story Characters|
|Protagonists||Quote • Curly Brace • Sue Sakamoto • King • Toroko • Kazuma Sakamoto • Professor Booster • Itoh • Momorin Sakamoto|
|Antagonists||Doctor • Misery • Balrog • Ballos|
|Others||Tetsuzou Kamadani • Jack • Mahin • Kanpachi • Sandaime • Arthur • Cthulhu • Santa • Chako • Malco • Colons • Jenka • Puppies • Chaba • Dr. Gero • Nurse Hasumi • Littles • Chie • Zett • Megane • Shovel Brigade • Numahachi • Ballos|
|Races||Robots • Mimiga • Humans • Cthulhu • Witches • Gaudi • Droll|