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The innovation which gave us the particular flat bread we call “pizza” was the use of tomato as a topping. For some time after the tomato was brought to Europe from the Americas in the 16th century, it was believed by many Europeans to be poisonous (as are some other fruits of the nightshade family) However, by the late 18th century it was common for the poor of the area around Naples to add tomato to their yeast-based flat bread and so the pizza was born. The dish gained in popularity and Pizza became a tourist attraction as visitors to Naples ventured into the poorer areas of the city to try the local specialty.

Until about 1830, pizza was often sold from open-air stands and street vendors out of pizza bakeries. The world’s first true pizzeria, Antica Pizzeria Port’Alba, opened in Naples in 1830 and still serves pizza from the same premises today. A description of pizza in Naples around 1830 is given by the French writer and food expert Alexandre Dumas, père in his work Le Corricolo, Chapter VIII. He writes that pizza was the only food of the humble people in Naples during winter, and that "in Naples pizza is flavored with oil, lard, tallow, cheese, tomato, or anchovies".

The Neapolitans take their pizza very seriously. Purists, like the famous pizzeria "Da Michele" in Via C.Sersale (founded: 1870) consider there to be only two true pizzas the "Marinara" and the "Margherita" and that is all they serve. The Marinara is the oldest and has a topping of tomato, oregano, garlic, extra virgin olive oil, and basil. It was named "Marinara" not, as many believe, because it has seafood on it (it doesn't) but because it was the food the fishermen ate when they returned home from fishing trips in the Bay of Naples. The Margherita introduced cheese to the pizza and is attributed to baker Raffaele Esposito. Esposito worked at the pizzeria "Pietro... e basta così" (literally "Peter... and that's enough" which was established in 1780 and is still operating under the name "Pizzeria Brandi"). In 1889, he baked three different pizzas for the visit of King Umberto I and Queen Margherita of Savoy. The Queen's favorite was a pizza evoking the colors of the Italian flag green (basil leaves), white (mozzarella), and red (tomatoes). This combination was named Pizza Margherita in her honor although the proprietors of Pizzeria Antica Port‘Alba maintain that the pizza Margherita had been around for a long time before it was named "Margherita" by Pizzeria Brandi.

The "Associazione Verace Pizza Napoletana" ("True Neapolitan Pizza Association"), which was founded in 1984 and only recognises the Marinara and Margherita, has set the very specific rules that must be followed for an authentic Neapolitan pizza. These include that the pizza must be baked in a wood-fired, domed oven at 485C for no more than 60 to 90 seconds; that the base must be hand-kneaded and must not be rolled with a pin or prepared by any mechanical means and that the pizza must not exceed 35 cm in diameter or be more than a third of a cm thick at the centre. There are many famous pizzerias in Naples where these traditional pizzas can be found like Da Michele, Port'Alba, Brandi, Di Matteo, Sorbillo, Trianon and Luigi Lombardi Di Santa Chiara. Most of them are centred on the ancient historical centre of Naples.