Sergeant Dennis Riley receives a distress call from Fort Stewart, a top secret research facility in Antarctica, where his special U.S. Marine Team Red Light is sent to investigate. However, their plane crashes in the tundra, and Dennis must fight for his life against mutated creatures as he discovers what has occurred at the facility.
Extermination is a survival horror game. The player character has limited ammunition and must often run away from monsters to survive. Additionally, the character's Infection Rate can increase when attacked by monsters, eventually leading to mutation if it reaches 100%. MTS vaccines can counteract infection.
The player character's default rifle can be customized with enhancements such as a zoom scope, flashlight grip, and radar. Other weapon types like flame thrower, shotgun, or rocket launcher can also be unlocked through parts upgrades. Dennis also has access to a knife for close combat. Throughout the game, batteries must be collected to activate machines and save the game.