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Preheat the oven to 400°F and line a large baking sheet with parchment paper.
Wash and chop the cauliflower into florets, then pulse in a food processor until it resembles rice.
Place the riced cauliflower in a microwave-safe bowl and microwave on high for 5–7 minutes until tender; let cool.
Transfer the cooled cauliflower to a clean kitchen towel or cheesecloth and squeeze out as much liquid as possible.
In a large bowl, combine the squeezed cauliflower, egg, ½ cup shredded part-skim mozzarella cheese, almond flour, dried oregano, garlic powder, salt, and black pepper; mix until a dough forms.
Press the cauliflower mixture into a 10–12 inch round on the prepared baking sheet, about ¼ inch thick, making the edges slightly thicker.
Bake the crust for 20–25 minutes, until golden brown and firm to the touch.
Remove the crust from the oven. Spread the marinara sauce evenly over it, leaving a small border. Top with 1 cup shredded part-skim mozzarella cheese, sliced pepperoni, bell pepper slices, and grated Parmesan cheese if using.
Return the pizza to the oven and bake for another 10–15 minutes, until the cheese is melted, bubbly, and the crust edges are golden brown.
Let the pizza cool on the baking sheet for 5–10 minutes before slicing and serving.