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A person's ass that is full of pimples and/or pockmarks; similar to how kids with acne were called "pizza`face" back in grade school, except this term is specific to the buttock area.
Matt: "Alex mooned me yesterday and I was like, 'damn! I didn't order no pepperoni & butthole pizza!'"
Cara: "Ha! I called him up and ordered it for you and he said he'd deliver for free."
Matt: "Well, there was way too much pepperoni for my liking."
Cara: "Yeah, and probably not enough butthole, huh? ha!"
Matt: "SIIIIIIICK!!!!"
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Pepperoni Pizza flavored condom that you hope stretches.
Dawg, I gave her a gigantic slice of pepperoni pizza blanket last night.