Necrobiosis lipoidica (NL) is a rare inflammatory granulomatous skin disorder of collagen degeneration with a risk of ulceration. There is a known association with diabetes mellitus. NL most commonly presents at 30-40 years of age, is more common in women, and frequently appears on the pre-tibial regions as erythematous papules that can unite to form telangiectatic plaques. Given the underlying pathological mechanism remains unclear, there is no uniform treatment pathway and there is no single treatment modality that has proven to be completely suitable in treating NL. In this report and literature review, we describe a case of a 31-year-old female with type-1 diabetes mellitus with biopsy proven NL of the dorsal left foot, refractory to multiple medical therapies and phototherapy. She proceeded to a wide local excision down to deep fascia and split thickness skin grafting. She progressed well post-operatively and has had no evidence of NL recurrence thus far. There is a paucity of reported literature describing the effectiveness of surgical management in NL, and this case adds to the literature available. While management of NL is nuanced and patient-dependent, excision and grafting can be considered and discussed with patients when counselling regarding management options. This has proven an effective strategy for patients with disease refractory to medical therapies, with low rates of recurrence when excised down to deep fascia. It is necessary to continue describing cases in this field and their management to aid in standardising the medical and surgical treatment and optimising outcomes for patients.