Well I play an N/Me and have only been down to the Underworld twice. The first time was an utter disaster, but the second time I knew more what I was in for.
As UW is full of high-armour huge-melee damage enemies, you want to take anti-melee hexes and armour-ignoring attack spells.
The build I ran was this:
Vampiric Gaze (Blood)
Shadow Strike (Blood)
Barbed Signet (Blood)
Shadow Of Fear (Curse)
Enfeebling Blood (Curse)
Well Of Blood (Blood)
{E} Blood Is Power (Blood)
Res Signet
Basically, use Shadow Of Fear and Enfeebling Blood to make the Aataxe's less intimidating, and use Shadow Strike, Vampiric Gaze and Barbed Signet to deal damage from range. Use Well of Blood to ease the load on Monks, along with effectively stopping Bleeding having that much of an effect. I took Blood is Power as my elite as it seems to be one of the only ways for a Necro to actually get into a PUG, however once I was inside, I found that it wasn't actually needed that much - a better choice might be Feast Of Corruption, when combined with Shadow Of Fear.
Oh and Attribute-wise:
12+1+3 Blood
12+1 Curse
3+1 Soul Reaping
Hope that helps - it's by no means a perfect build, but worked for me.
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