Healthcare institutions routinely accumulate high-dimensional computed tomography (CT) volumes, but only a fraction can be annotated by experts. We present L2GSSL, a local-to-global self-supervised learning framework that leverages unlabeled volumes by decomposing pretraining into intra-slice and inter-slice representation spaces. A slice encoder learns view-invariant local features, and a global encoder aggregates the resulting tokens to model volumetric context. The stop-gradient isolates the local space from the global objective, while slice-wise execution and a three-phase schedule support training under constrained GPU memory. On LIDC-IDRI lung nodule malignancy classification, L2GSSL reaches $0.9229$ AUROC with only $10\%$ of the labels and $0.9377$ with $25\%$, exceeding the volume-level VICReg by $0.0229$ and $0.0294$, respectively. With all labels, the strongest supervised baseline exceeds L2GSSL by only $0.0044$ AUROC, consistent with self-supervised pretraining providing its greatest value when annotations are limited. Without adaptation to the external LNDb cohort, a model fine-tuned on $25\%$ of LIDC-IDRI obtains $0.8138$ AUROC and $0.7589$ AUPRC, improving over the strongest evaluated self-supervised baseline by $0.1130$ and $0.0954$. Experiments across data sources, thoracic and abdominal anatomy, downstream tasks, and two backbones examine healthcare-data variety, while lesion-slice masking shows that the predictions depend on lesion-bearing content.

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